Provider Demographics
NPI:1497946909
Name:PATTEN, BRIAN DALE (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DALE
Last Name:PATTEN
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 1:2840 E 101ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5601
Mailing Address - Country:US
Mailing Address - Phone:918-518-6305
Mailing Address - Fax:918-518-6327
Practice Address - Street 1:530 PLAZA CT
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7915
Practice Address - Country:US
Practice Address - Phone:918-245-8333
Practice Address - Fax:918-245-8338
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice