Provider Demographics
NPI:1265655286
Name:PATINO, GLORIA E (DMD)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:E
Last Name:PATINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S. MAIN ST.
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2043
Mailing Address - Country:US
Mailing Address - Phone:862-397-4282
Mailing Address - Fax:862-397-4282
Practice Address - Street 1:400 S. MAIN ST.
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:862-397-4282
Practice Address - Fax:862-397-4285
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021553001223G0001X
NJD1021553001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice