Provider Demographics
NPI:1205400736
Name:RUPERT, PATRICK STEVEN (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:STEVEN
Last Name:RUPERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALLWOOD DR APT C
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1129
Mailing Address - Country:US
Mailing Address - Phone:724-388-6023
Mailing Address - Fax:
Practice Address - Street 1:656 DOWNINGTOWN PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2226
Practice Address - Country:US
Practice Address - Phone:610-429-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0430701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice