Provider Demographics
NPI:1669571535
Name:PATTERSON, GARY T (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BRADY CIR W
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1411
Mailing Address - Country:US
Mailing Address - Phone:740-282-5100
Mailing Address - Fax:740-282-1700
Practice Address - Street 1:141 BRADY CIR W
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1411
Practice Address - Country:US
Practice Address - Phone:740-282-5100
Practice Address - Fax:740-282-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0520243Medicaid
OH0520243Medicaid
OHT28583Medicare UPIN