Provider Demographics
NPI:1275761124
Name:SO, PATRICK TING (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:TING
Last Name:SO
Suffix:
Gender:M
Credentials:DDS
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 IRONHORSE PKWY
Mailing Address - Street 2:#436
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2043
Mailing Address - Country:US
Mailing Address - Phone:347-853-4735
Mailing Address - Fax:
Practice Address - Street 1:2390 COUNTRY HILLS DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-7437
Practice Address - Country:US
Practice Address - Phone:925-757-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA584081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry