Provider Demographics
NPI:1841701471
Name:PADILLA, JOSE LUIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:PADILLA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 S JACKSON RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7832
Mailing Address - Country:US
Mailing Address - Phone:956-322-3827
Mailing Address - Fax:
Practice Address - Street 1:4451 S JACKSON RD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7832
Practice Address - Country:US
Practice Address - Phone:563-223-8279
Practice Address - Fax:956-322-5421
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33489390200000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program