Provider Demographics
NPI:1770037038
Name:PATTERSON, THOMAS JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 RIVER VISTA PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4078
Mailing Address - Country:US
Mailing Address - Phone:208-737-5253
Mailing Address - Fax:
Practice Address - Street 1:236 RIVER VISTA PL STE 100
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4078
Practice Address - Country:US
Practice Address - Phone:208-737-5253
Practice Address - Fax:208-737-5255
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9867638-9921122300000X
IDD-51121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist