Provider Demographics
NPI:1922020387
Name:PATTY, STEVEN RUSSELL (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:PATTY
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 WELLNESS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7774
Mailing Address - Country:US
Mailing Address - Phone:704-291-7333
Mailing Address - Fax:704-292-1203
Practice Address - Street 1:1851 WELLNESS BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7774
Practice Address - Country:US
Practice Address - Phone:704-291-7333
Practice Address - Fax:704-292-1203
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996674Medicaid
PA583212OtherUNITED CONCORDIA INS
SCZN5322Medicaid
NC96674OtherBLUE CROSS BLUE SHIELD NC
CO328400OtherTRIGON BCBS INS
CO328400OtherTRIGON BCBS INS
NC96674OtherBLUE CROSS BLUE SHIELD NC
NCT63974Medicare UPIN