Provider Demographics
NPI:1417088238
Name:RICHARD E PATRICK DDS PA
Entity Type:Organization
Organization Name:RICHARD E PATRICK DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-491-1191
Mailing Address - Street 1:4500 COLLEGE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1799
Mailing Address - Country:US
Mailing Address - Phone:913-491-1191
Mailing Address - Fax:913-491-1192
Practice Address - Street 1:4500 COLLEGE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1799
Practice Address - Country:US
Practice Address - Phone:913-491-1191
Practice Address - Fax:913-491-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5541261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental