Provider Demographics
NPI:1508950270
Name:BERUBE, PATRICIA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:BERUBE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 UNICORN LAKE BLVD.
Mailing Address - Street 2:SUITE 151
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-384-7374
Mailing Address - Fax:940-384-7370
Practice Address - Street 1:3313 UNICORN LAKE BLVD.
Practice Address - Street 2:SUITE 151
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-384-7374
Practice Address - Fax:940-384-7370
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics