Provider Demographics
NPI:1326170929
Name:PATCH, ALLAN KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:KENT
Last Name:PATCH
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 1:6324 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5813
Mailing Address - Country:US
Mailing Address - Phone:619-582-4224
Mailing Address - Fax:619-582-4280
Practice Address - Street 1:6324 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5813
Practice Address - Country:US
Practice Address - Phone:619-582-4224
Practice Address - Fax:619-582-4280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0341861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice