Provider Demographics
NPI:1912975202
Name:PATE, PETER A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:PATE
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 1:91 W. WIEUCA RD, NE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-266-9424
Mailing Address - Fax:404-261-4526
Practice Address - Street 1:91 W WIEUCA RD, NE
Practice Address - Street 2:SUITE 4000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-266-9424
Practice Address - Fax:404-261-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106461223G0001X
GA0106461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice