Healthcare Provider Details

I. General information

NPI: 1649106030
Provider Name (Legal Business Name): PATRICIA MADDOX BANDY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 SHALLOWFORD RD
CHATTANOOGA TN
37421-2239
US

IV. Provider business mailing address

6106 SHALLOWFORD RD
CHATTANOOGA TN
37421-2239
US

V. Phone/Fax

Practice location:
  • Phone: 423-296-1053
  • Fax:
Mailing address:
  • Phone: 423-296-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13174
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: