Provider Demographics
NPI:1700093960
Name:PATTERSON, MAX H (DDS)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:H
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1420
Mailing Address - Country:US
Mailing Address - Phone:620-223-5210
Mailing Address - Fax:620-223-5213
Practice Address - Street 1:103 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1420
Practice Address - Country:US
Practice Address - Phone:620-223-5210
Practice Address - Fax:620-223-5213
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice