Provider Demographics
NPI:1033172671
Name:PATTERSON, SANDRA (DMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN CROYLE
Other - Last Name:CROYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:129 HILLCREST SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3504
Practice Address - Country:US
Practice Address - Phone:724-337-7800
Practice Address - Fax:724-337-9982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009833460010Medicaid
PA1009833460015Medicaid
PA1009833460003Medicaid
PA1009833460004Medicaid
PA1009833460012Medicaid
PA1009833460013Medicaid
PA1009833460014Medicaid
PA1009833460005Medicaid
PA1009833460009Medicaid
PA1009833460001Medicaid
PA1009833460006Medicaid
PA1009833460011Medicaid
PA1009833460008Medicaid