Provider Demographics
NPI:1255461836
Name:PATTEN, PAMELA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:PATTEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1840 E CALVADA BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5866
Mailing Address - Country:US
Mailing Address - Phone:775-727-6006
Mailing Address - Fax:775-727-6001
Practice Address - Street 1:1840 E CALVADA BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5866
Practice Address - Country:US
Practice Address - Phone:775-727-6006
Practice Address - Fax:775-727-6001
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502358Medicaid