Provider Demographics
NPI:1821315433
Name:PATTERSON, CHRISTOPHER ADAM
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ADAM
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S POTOMAC WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1375
Mailing Address - Country:US
Mailing Address - Phone:720-290-4789
Mailing Address - Fax:
Practice Address - Street 1:390 S POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1375
Practice Address - Country:US
Practice Address - Phone:303-367-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34851223G0001X
CODEN107171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36685763Medicaid