Provider Demographics
NPI:1598986044
Name:PATINO, HAROLD
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:PATINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 FAWELL COURT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-428-4228
Mailing Address - Fax:
Practice Address - Street 1:2760 FORGUE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4173
Practice Address - Country:US
Practice Address - Phone:630-536-1900
Practice Address - Fax:630-536-1906
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210019931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery