Healthcare Provider Details

I. General information

NPI: 1205138708
Provider Name (Legal Business Name): DR DANIEL J PATTI D.M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 NORTH JACKSON ST. SUITE E
BROOKHAVEN MS
39601-2912
US

IV. Provider business mailing address

439 NORTH JACKSON ST. SUITE E
BROOKHAVEN MS
39601-2912
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-0777
  • Fax: 601-833-6606
Mailing address:
  • Phone: 601-833-0777
  • Fax: 601-833-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL J PATTI
Title or Position: OWNER
Credential: D.M.D.
Phone: 601-833-0777