Provider Demographics
NPI:1356699094
Name:SHAWANA PATTERSON, DDS, PA
Entity type:Organization
Organization Name:SHAWANA PATTERSON, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-607-1535
Mailing Address - Street 1:801 PHILLIPS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7293
Mailing Address - Country:US
Mailing Address - Phone:336-812-3104
Mailing Address - Fax:336-812-3105
Practice Address - Street 1:801 PHILLIPS AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7293
Practice Address - Country:US
Practice Address - Phone:336-812-3104
Practice Address - Fax:336-812-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9248261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery