Provider Demographics
NPI:1992826820
Name:PATTON, ROBERT MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:PATTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-0979
Mailing Address - Country:US
Mailing Address - Phone:512-346-8830
Mailing Address - Fax:512-472-5713
Practice Address - Street 1:6012 W WILLIAM CANNON DR
Practice Address - Street 2:B101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1980
Practice Address - Country:US
Practice Address - Phone:512-346-8830
Practice Address - Fax:512-472-5713
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12314204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27864Medicare UPIN