Provider Demographics
NPI:1710906292
Name:PATTERSON, JENNIFER P
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 ORLEANS RD
Mailing Address - Street 2:UNIT L
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4815
Mailing Address - Country:US
Mailing Address - Phone:843-573-0733
Mailing Address - Fax:843-573-1065
Practice Address - Street 1:946 ORLEANS RD
Practice Address - Street 2:UNIT L
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4815
Practice Address - Country:US
Practice Address - Phone:843-573-0733
Practice Address - Fax:843-573-1065
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3997Medicaid