Provider Demographics
NPI:1679233407
Name:PATAO DENTAL CORPORATION
Entity Type:Organization
Organization Name:PATAO DENTAL CORPORATION
Other - Org Name:DEREK PATAO DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-515-4386
Mailing Address - Street 1:932 N BRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:932 N BRAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2905
Practice Address - Country:US
Practice Address - Phone:818-843-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental