Provider Demographics
NPI:1023290517
Name:PATTERSON, GARNET L (DDS)
Entity type:Individual
Prefix:DR
First Name:GARNET
Middle Name:L
Last Name:PATTERSON
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 1:19721 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1307
Mailing Address - Country:US
Mailing Address - Phone:708-479-5865
Mailing Address - Fax:708-479-4630
Practice Address - Street 1:19721 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1307
Practice Address - Country:US
Practice Address - Phone:708-479-5865
Practice Address - Fax:708-479-4630
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003276Medicaid
IL1003276Medicaid