Provider Demographics
NPI:1710053517
Name:PATTEN, SIDNEY ROGER (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:ROGER
Last Name:PATTEN
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:17600 TALBOT ROAD SOUTH
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-277-0670
Mailing Address - Fax:425-228-1644
Practice Address - Street 1:17600 TALBOT ROAD SOUTH
Practice Address - Street 2:SUITE 5
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-277-0670
Practice Address - Fax:425-228-1644
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000041211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics