Provider Demographics
NPI:1366677593
Name:DENTAL DESIGNS OF STROUD, LLC
Entity Type:Organization
Organization Name:DENTAL DESIGNS OF STROUD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-968-1606
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-3613
Mailing Address - Country:US
Mailing Address - Phone:918-968-1606
Mailing Address - Fax:918-968-1635
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-3613
Practice Address - Country:US
Practice Address - Phone:918-968-1606
Practice Address - Fax:918-968-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5990261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200119850AMedicaid