Provider Demographics
NPI:1821266149
Name:DR. MICHAEL PATTERSON, DDS, PC
Entity Type:Organization
Organization Name:DR. MICHAEL PATTERSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-782-0400
Mailing Address - Street 1:2700 MCCLELLAND BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1623
Mailing Address - Country:US
Mailing Address - Phone:417-782-0400
Mailing Address - Fax:417-206-6230
Practice Address - Street 1:2700 MCCLELLAND BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1623
Practice Address - Country:US
Practice Address - Phone:417-782-0400
Practice Address - Fax:417-206-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty