Provider Demographics
NPI:1982607974
Name:PATE, DWIGHT H (DMD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:H
Last Name:PATE
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 1:306 PILAKLAKAHA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3321
Mailing Address - Country:US
Mailing Address - Phone:863-967-1233
Mailing Address - Fax:863-967-7603
Practice Address - Street 1:306 PILAKLAKAHA AVE
Practice Address - Street 2:STE A
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3321
Practice Address - Country:US
Practice Address - Phone:863-967-1233
Practice Address - Fax:863-967-7603
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 105921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice