Healthcare Provider Details

I. General information

NPI: 1053306142
Provider Name (Legal Business Name): DAN ELDON PATTERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9118 S TOLEDO AVE
TULSA OK
74137-2700
US

IV. Provider business mailing address

3606 W VISTA LN
STILLWATER OK
74074-7602
US

V. Phone/Fax

Practice location:
  • Phone: 918-495-1800
  • Fax: 918-495-1890
Mailing address:
  • Phone: 405-624-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3668
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: