Provider Demographics
NPI:1023206448
Name:PATRIE, THOMAS COLLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:COLLIN
Last Name:PATRIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:260 E MAIN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:631-361-3577
Mailing Address - Fax:631-361-6162
Practice Address - Street 1:3250 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3320
Practice Address - Country:US
Practice Address - Phone:631-689-9719
Practice Address - Fax:631-689-9730
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice