Provider Demographics
NPI:1003815754
Name:PATTERSON, LARRY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:K
Last Name:PATTERSON
Suffix:
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:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-0347
Mailing Address - Country:US
Mailing Address - Phone:918-623-2910
Mailing Address - Fax:918-623-2943
Practice Address - Street 1:321 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2607
Practice Address - Country:US
Practice Address - Phone:918-623-2910
Practice Address - Fax:918-623-2943
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice