Healthcare Provider Details

I. General information

NPI: 1285964213
Provider Name (Legal Business Name): ROBERT E PATTERSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N WINDSONG DR SUITE 201
PRESCOTT VALLEY AZ
86314-2290
US

IV. Provider business mailing address

3033 N WINDSONG DR SUITE 201
PRESCOTT VALLEY AZ
86314-2290
US

V. Phone/Fax

Practice location:
  • Phone: 928-772-7353
  • Fax: 928-775-4420
Mailing address:
  • Phone: 928-772-7353
  • Fax: 928-775-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD7881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: