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General NPI Number Information
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NPI Number | 1306121124
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Entity Type | Organization
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Legal Business Name | PATTERSON DENTAL CENTER
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 6002 SUMMERFIELD DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4303
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Country | US
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Telephone | 903-791-0150
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Fax | 903-791-0201
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Provider Business Mailing Address
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Address Line | 6002 SUMMERFIELD DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4303
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Country | US
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Telephone | 903-791-0150
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Fax | 903-791-0201
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHAD M PATTERSON
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Credential | DDS
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Telephone | 903-791-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23520
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License Number State | TX
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