Provider Demographics
NPI:1942396817
Name:PATINO, STELLA PATRICIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:PATRICIA
Last Name:PATINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:PATRICIA
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 E. 3RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4201
Mailing Address - Country:US
Mailing Address - Phone:760-740-5979
Mailing Address - Fax:760-740-0612
Practice Address - Street 1:127 E 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4201
Practice Address - Country:US
Practice Address - Phone:760-740-5979
Practice Address - Fax:760-740-0612
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist