Healthcare Provider Details

I. General information

NPI: 1518914621
Provider Name (Legal Business Name): HAYDEN PATINO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 PARRS RIDGE DR
SPENCERVILLE MD
20868-3300
US

IV. Provider business mailing address

1122 PARRS RIDGE DR
SPENCERVILLE MD
20868-3300
US

V. Phone/Fax

Practice location:
  • Phone: 301-476-9108
  • Fax:
Mailing address:
  • Phone: 301-476-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10016
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: