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NPI Code Detail

MEDICARE: DR. PHILLIP H. PATRIDGE DMD

MEDICARE: DR. PHILLIP H. PATRIDGE DMD
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
11223G0001XGeneral Practice Dentistry2029-83MS

General Provider Information

NPI Number : 1952369530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILLIP H. PATRIDGE DMD
Provider Business Mailing Address
First Line : 351 W 6TH ST
Second Line : SUITE 100
City : FORT STEWART
State : GA
Zip : 31314-4703
Country : US
Telephone Number : 912-767-6735
Fax Number : 912-767-5425
Provider Business Practice Location Address
First Line : 351 W 6TH ST
Second Line : SUITE 100
City : FORT STEWART
State : GA
Zip : 31314-4703
Country : US
Telephone Number : 912-767-6735
Fax Number : 912-767-5425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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Directions to “ DR. PHILLIP H. PATRIDGE DMD” Practice Location

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