Provider Demographics
NPI:1619288461
Name:RIST, PATRICIA HANLON (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HANLON
Last Name:RIST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-1914
Mailing Address - Country:US
Mailing Address - Phone:302-765-3373
Mailing Address - Fax:
Practice Address - Street 1:4201 MILLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-1914
Practice Address - Country:US
Practice Address - Phone:302-765-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0386001223P0221X
DEG1-00013811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry