Provider Demographics
NPI:1083055974
Name:PATERRA, CHAD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:PATERRA
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 1:409 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3260
Mailing Address - Country:US
Mailing Address - Phone:304-670-9637
Mailing Address - Fax:
Practice Address - Street 1:409 PENNY LN
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3260
Practice Address - Country:US
Practice Address - Phone:304-670-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4065122300000X
NC98611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist