Healthcare Provider Details

I. General information

NPI: 1427383983
Provider Name (Legal Business Name): BRIAN CHRISTOPHER PATERSON DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MAIN ST SUITE 103
MATAWAN NJ
07747-4104
US

IV. Provider business mailing address

158 MAIN ST SUITE 103
MATAWAN NJ
07747-4104
US

V. Phone/Fax

Practice location:
  • Phone: 732-566-7648
  • Fax:
Mailing address:
  • Phone: 732-566-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS038162
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02597600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: