Provider Demographics
NPI:1033215413
Name:PATRICIA PATINO DDS INC
Entity Type:Organization
Organization Name:PATRICIA PATINO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-740-5979
Mailing Address - Street 1:301 S JUNIPER STREET
Mailing Address - Street 2:
Mailing Address - City:ESCOUDIDO
Mailing Address - State:GA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-740-5979
Mailing Address - Fax:
Practice Address - Street 1:301 S JUNIPER STREET
Practice Address - Street 2:
Practice Address - City:ESCOUDIDO
Practice Address - State:GA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-740-5979
Practice Address - Fax:760-740-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty