Provider Demographics
NPI:1891901153
Name:PERSON, PATRICK R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:PERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 WOLF RIVER CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1750
Mailing Address - Country:US
Mailing Address - Phone:901-681-0777
Mailing Address - Fax:901-767-0777
Practice Address - Street 1:7675 WOLF RIVER CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1750
Practice Address - Country:US
Practice Address - Phone:901-681-0777
Practice Address - Fax:901-767-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000051261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0138845OtherBLUE CROSS BLUE SHIELD
791594OtherUNITED CONCORDIA