Provider Demographics
NPI:1033348271
Name:CONN, PATRICIA VERONIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:VERONIKA
Last Name:CONN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 MAIN ST
Mailing Address - Street 2:P.O. BOX 877
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9212
Mailing Address - Country:US
Mailing Address - Phone:360-384-5902
Mailing Address - Fax:360-384-5732
Practice Address - Street 1:2372 MAIN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9212
Practice Address - Country:US
Practice Address - Phone:360-384-5902
Practice Address - Fax:360-384-5732
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60034327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist