Provider Demographics
NPI:1942534524
Name:PATRICK, HARRY JAMES PETER (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:JAMES PETER
Last Name:PATRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:H.J.
Other - Middle Name:PETER
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1001 HANSHAW RD.
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-257-5700
Mailing Address - Fax:
Practice Address - Street 1:1001 HANSHAW RD.
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist