Individual provider Active NPI

Adolph Ralph Padula, DDS

  • General Practice Dentistry
  • Pueblo, CO
National Provider Identifier
1881671436
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3209 Issued in CO
Practice address
1022 Liberty LN
Pueblo, CO 81001-2039
Phone
(719) 545-5778
Fax
(719) 545-5783
NPI assigned
Dec 26, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 051116 NY
General Practice Dentistry 1223G0001X D-3858 ID
General Practice Dentistry 1223G0001X 22044 OH
General Practice Dentistry 1223G0001X 12010429A IN
General Practice Dentistry 1223G0001X 5641 OK
General Practice Dentistry 1223G0001X 5641 AZ
General Practice Dentistry 1223G0001X 4778T NV
General Practice Dentistry 1223G0001X 60210 KS
General Practice Dentistry 1223G0001X DD2043 NM
General Practice Dentistry 1223G0001X 1134 WY
General Practice Dentistry 1223G0001X 3209 CO Primary
General Practice Dentistry 1223G0001X 21280 MA

Addresses

Primary practice location

1022 Liberty LN
Pueblo, CO 81001-2039

Mailing address

415 N Grand Ave
Pueblo, CO 81003-3111
Phone (719) 546-3333

Other identifiers 4

IdentifierTypeStateIssuer
0204889MedicaidMA
703167MedicaidAZ
02551637MedicaidNY
2525048MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3209COMDGeneral Practice Dentistry
D-3858IDMDGeneral Practice Dentistry
12010429AINMDGeneral Practice Dentistry
60210KSMDGeneral Practice Dentistry
21280MAMDGeneral Practice Dentistry
DD2043NMMDGeneral Practice Dentistry
4778TNVMDGeneral Practice Dentistry
22044OHMDGeneral Practice Dentistry
1134WYMDGeneral Practice Dentistry
051116NYMDPharmacist
5641AZMDRegistered Respiratory Therapist

NPI Registry JSON

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

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1881671436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N GRAND AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033111",
            "telephone_number": "719-546-3333",
            "fax_number": "719-546-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 LIBERTY LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810012039",
            "telephone_number": "719-545-5778",
            "fax_number": "719-545-5783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADULA",
        "first_name": "ADOLPH",
        "middle_name": "RALPH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-26",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051116",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3858",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "22044",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010429A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5641",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "5641",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4778T",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60210",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD2043",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "1134",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "3209",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "21280",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0204889",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703167",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02551637",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2525048",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.