Provider Demographics
NPI:1619142270
Name:NASSETTA, PATRICK CONRAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CONRAD
Last Name:NASSETTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 BROCKS GAP PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4032
Mailing Address - Country:US
Mailing Address - Phone:205-982-0112
Mailing Address - Fax:
Practice Address - Street 1:1015 BROCKS GAP PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4032
Practice Address - Country:US
Practice Address - Phone:205-982-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry