Provider Demographics
NPI:1841232113
Name:CLEVES, PATTI JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATTI
Middle Name:JANE
Last Name:CLEVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6901
Mailing Address - Country:US
Mailing Address - Phone:405-722-6028
Mailing Address - Fax:405-720-2435
Practice Address - Street 1:4514 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-6901
Practice Address - Country:US
Practice Address - Phone:405-722-6028
Practice Address - Fax:405-720-2435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice