MEDICARE: BRIAN DALE PATTEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5990	OK

General Provider Information

NPI Number	:	1497946909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DALE PATTEN DDS

Provider Business Mailing Address
First Line	:	2840 E 101ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-5601
Country	:	US
Telephone Number	:	918-518-6305
Fax Number	:	918-518-6327

Provider Business Practice Location Address
First Line	:	530 PLAZA CT
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7915
Country	:	US
Telephone Number	:	918-245-8333
Fax Number	:	918-245-8338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	03/19/2013

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Directions to “ BRIAN DALE PATTEN DDS” Practice Location

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