MEDICARE: DR. MARLICE ARCANGEL PATAM D.D.S., M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	42757	CA

General Provider Information

NPI Number	:	1730203712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLICE ARCANGEL PATAM D.D.S., M.D.

Provider Business Mailing Address
First Line	:	1115 MONTROSE AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3435
Country	:	US
Telephone Number	:	626-394-4946
Fax Number	:	626-296-2779

Provider Business Practice Location Address
First Line	:	1115 MONTROSE AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3435
Country	:	US
Telephone Number	:	626-394-4946
Fax Number	:	626-296-2779

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/23/2010

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