Provider Demographics
NPI:1982796777
Name:PATRICK, CYNTHIA TUDOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:TUDOR
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:KAY
Other - Last Name:TUDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3400
Mailing Address - Country:US
Mailing Address - Phone:540-347-4154
Mailing Address - Fax:540-347-0567
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3400
Practice Address - Country:US
Practice Address - Phone:540-347-4154
Practice Address - Fax:540-347-0567
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice