Provider Demographics
NPI:1508184839
Name:PATTERSON, MAILIKI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAILIKI
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 SE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9398
Mailing Address - Country:US
Mailing Address - Phone:503-332-7460
Mailing Address - Fax:
Practice Address - Street 1:2383 SE MEADOW CT
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9398
Practice Address - Country:US
Practice Address - Phone:503-332-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist