Provider Demographics
NPI:1629051057
Name:PATTERSON, TERESE M
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:M
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:12103 OAKWOOD VIEW DR
Mailing Address - Street 2:APT 305
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6880
Mailing Address - Country:US
Mailing Address - Phone:843-364-7350
Mailing Address - Fax:
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 42
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-661-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40661223G0001X
NC86491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice