Healthcare Provider Details

I. General information

NPI: 1992313068
Provider Name (Legal Business Name): ZACHARY PATTERSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 PROFESSIONAL PKWY
AUGUSTA GA
30907-6527
US

IV. Provider business mailing address

1454 WACCAMAW DR
NORTH AUGUSTA SC
29841-2023
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-8155
  • Fax:
Mailing address:
  • Phone: 229-425-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN016075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: