Provider Demographics
NPI:1245329283
Name:ROONEY, PATRICK JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:ROONEY
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 1:215 MARINE DR
Mailing Address - Street 2:215 MARINE DR. #1
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4036
Mailing Address - Country:US
Mailing Address - Phone:360-332-2400
Mailing Address - Fax:360-332-7161
Practice Address - Street 1:215 MARINE DR #1
Practice Address - Street 2:215 MARINE DR. #1
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4036
Practice Address - Country:US
Practice Address - Phone:360-332-2400
Practice Address - Fax:360-332-7161
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000075411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028790Medicaid
WAR07541OtherREGENCE BLUE SHEILD
WA975913OtherUNITED CONCORDIA