Provider Demographics
NPI:1710908991
Name:GORDON L. PATTISON, D.D.S., APDC
Entity Type:Organization
Organization Name:GORDON L. PATTISON, D.D.S., APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTISON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-473-3800
Mailing Address - Street 1:11859 WILSHIRE BLVD
Mailing Address - Street 2:STE. 550
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6616
Mailing Address - Country:US
Mailing Address - Phone:310-473-3800
Mailing Address - Fax:310-473-9107
Practice Address - Street 1:11859 WILSHIRE BLVD
Practice Address - Street 2:STE. 550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6616
Practice Address - Country:US
Practice Address - Phone:310-473-3800
Practice Address - Fax:310-473-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty