Provider Demographics
NPI:1952782724
Name:PATRICK, DYLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:PATRICK
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 1:419 W SOUTHWEST LOOP 323 STE 300
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7062
Mailing Address - Country:US
Mailing Address - Phone:903-251-9292
Mailing Address - Fax:
Practice Address - Street 1:419 W SOUTHWEST LOOP 323 STE 300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7062
Practice Address - Country:US
Practice Address - Phone:903-251-9292
Practice Address - Fax:903-207-8642
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310231223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry