Healthcare Provider Details

I. General information

NPI: 1649266917
Provider Name (Legal Business Name): NATHAN ELLIOT PATTERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 W CONNEXION WAY SUITE A
COLUMBIA CITY IN
46725-1037
US

IV. Provider business mailing address

788 W CONNEXION WAY SUITE A
COLUMBIA CITY IN
46725-1037
US

V. Phone/Fax

Practice location:
  • Phone: 260-248-4858
  • Fax: 260-248-4859
Mailing address:
  • Phone: 260-248-4858
  • Fax: 260-248-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010560A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: