Provider Demographics
NPI:1922153600
Name:PATTEN, KARYL COOPER (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:KARYL
Middle Name:COOPER
Last Name:PATTEN
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 RIVERVIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4240
Mailing Address - Country:US
Mailing Address - Phone:770-639-3477
Mailing Address - Fax:404-588-0226
Practice Address - Street 1:35 WHITEFOORD AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1727
Practice Address - Country:US
Practice Address - Phone:404-588-0101
Practice Address - Fax:404-588-0226
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0116441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00738537EMedicaid
GA00738537GMedicaid