Provider Demographics
NPI:1164595740
Name:PATRITTI, MARIO DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:DANIEL
Last Name:PATRITTI
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 1:8708 JUSTICE AVE
Mailing Address - Street 2:SUITE 2-K
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4575
Mailing Address - Country:US
Mailing Address - Phone:718-424-1900
Mailing Address - Fax:310-540-7579
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:SUITE 2-K
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-424-1900
Practice Address - Fax:310-540-7579
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039896-11223X0400X
CA383471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics