Provider Demographics
NPI:1245307867
Name:MADDY, PATRICK NEAL (DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:NEAL
Last Name:MADDY
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 1:2250 MOSTELLER ESTATE AVE SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602
Mailing Address - Country:US
Mailing Address - Phone:828-638-9377
Mailing Address - Fax:
Practice Address - Street 1:3070 11TH AVE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-695-5776
Practice Address - Fax:828-695-2101
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909251Medicaid
KY60051190Medicaid