Mark Robin Paden, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

34753 Issued in CA

Practice address

3609 Coffee Rd
Suite 1
Modesto, CA 95355-1100

Phone

(209) 577-3429

Fax

(209) 575-0724

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1558412015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3609 COFFEE RD",
            "address_2": "SUITE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551100",
            "telephone_number": "209-577-3429",
            "fax_number": "209-575-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3609 COFFEE RD",
            "address_2": "SUITE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551100",
            "telephone_number": "209-577-3429",
            "fax_number": "209-575-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADEN",
        "first_name": "MARK",
        "middle_name": "ROBIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "34753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Aimee Pacursa
• Alyson Kate Padgett, BCBA
• Randi Padgett
• Myrella Padilla Lopez
• Isabella M Padilla Pereira
• Daisy Padilla-Fonseca

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.