Provider Demographics
NPI:1447399217
Name:TODD, PATRICK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:TODD
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:PO BOX 828
Mailing Address - Street 2:1052 VILLAGE HIGHWAY
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-0828
Mailing Address - Country:US
Mailing Address - Phone:434-332-5919
Mailing Address - Fax:434-332-1740
Practice Address - Street 1:1052 VILLAGE HIGHWAY
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588
Practice Address - Country:US
Practice Address - Phone:434-332-5919
Practice Address - Fax:434-332-1740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice