Provider Demographics
NPI:1053306142
Name:PATTERSON, DAN ELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ELDON
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 1:3606 W VISTA LN
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-7602
Mailing Address - Country:US
Mailing Address - Phone:405-624-8864
Mailing Address - Fax:
Practice Address - Street 1:9118 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2700
Practice Address - Country:US
Practice Address - Phone:918-495-1800
Practice Address - Fax:918-495-1890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK681024OtherUNITED CONCORDIA ID #
OKT75390Medicare UPIN