Provider Demographics
NPI:1518208644
Name:PATRICIA BERUBE DMD MS PA
Entity Type:Organization
Organization Name:PATRICIA BERUBE DMD MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:940-384-7374
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:76210-0129
Mailing Address - Country:US
Mailing Address - Phone:940-384-7374
Mailing Address - Fax:
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:76210-0129
Practice Address - Country:US
Practice Address - Phone:940-384-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty