Healthcare Provider Details

I. General information

NPI: 1851099626
Provider Name (Legal Business Name): CHASE PATTON DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 FALLING LEAF CT
COLUMBIA MO
65201-3549
US

IV. Provider business mailing address

3005 FALLING LEAF CT
COLUMBIA MO
65201-3549
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-7040
  • Fax:
Mailing address:
  • Phone: 573-875-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT CHARLES PATTON III
Title or Position: OWNER
Credential: DDS
Phone: 573-818-4325