Provider Demographics
NPI:1336176361
Name:PATTERSON, CHARLES JOHN JR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:JOHN
Other - Last Name:PATTERSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:4514 COLE AVE
Mailing Address - Street 2:SUITE 920
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5412
Mailing Address - Country:US
Mailing Address - Phone:214-526-3434
Mailing Address - Fax:214-526-3439
Practice Address - Street 1:4514 COLE AVE
Practice Address - Street 2:SUITE 920
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5412
Practice Address - Country:US
Practice Address - Phone:214-526-3434
Practice Address - Fax:214-526-3439
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics