Provider Demographics
NPI:1417036757
Name:PRENDERGAST, PATRICK T (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:PRENDERGAST
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 1:6979 S HOLLY CIR
Mailing Address - Street 2:SUITE 185
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1065
Mailing Address - Country:US
Mailing Address - Phone:303-771-0225
Mailing Address - Fax:303-773-3726
Practice Address - Street 1:6979 S HOLLY CIR
Practice Address - Street 2:SUITE 185
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1065
Practice Address - Country:US
Practice Address - Phone:303-771-0225
Practice Address - Fax:303-773-3726
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1051751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice