Provider Demographics
NPI:1942422746
Name:PATI, FERDINAND DE AUSEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:DE AUSEN
Last Name:PATI
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 1:918 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1224
Mailing Address - Country:US
Mailing Address - Phone:818-502-9925
Mailing Address - Fax:818-502-1011
Practice Address - Street 1:918 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1224
Practice Address - Country:US
Practice Address - Phone:818-502-9925
Practice Address - Fax:818-502-1011
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB47304Medicaid