Provider Demographics
NPI:1225229131
Name:PEYTON, PATRICIA ANNE (RDH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:PEYTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:PEYTON-HEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1245 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2895
Mailing Address - Country:US
Mailing Address - Phone:541-888-6433
Mailing Address - Fax:541-888-7505
Practice Address - Street 1:1245 FULTON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2895
Practice Address - Country:US
Practice Address - Phone:541-888-6433
Practice Address - Fax:541-888-7505
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2831124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist