Provider Demographics
NPI:1366649717
Name:DENTICO, PATRICK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:DENTICO
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 1:1 CRAMER RD
Mailing Address - Street 2:APT. A
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1175
Mailing Address - Country:US
Mailing Address - Phone:845-516-4080
Mailing Address - Fax:
Practice Address - Street 1:25 PINE STREET
Practice Address - Street 2:
Practice Address - City:TIVOLI
Practice Address - State:NY
Practice Address - Zip Code:12583-5452
Practice Address - Country:US
Practice Address - Phone:845-757-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice