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General NPI Number Information
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NPI Number | 1356699094
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Entity Type | Organization
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Legal Business Name | SHAWANA PATTERSON, DDS, PA
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 801 PHILLIPS AVE STE 105
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City | HIGH POINT
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State | NC
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Zip | 27262-7293
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Country | US
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Telephone | 336-812-3104
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Fax | 336-812-3105
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Provider Business Mailing Address
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Address Line | 801 PHILLIPS AVE STE 105
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City | HIGH POINT
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State | NC
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Zip | 27262-7293
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Country | US
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Telephone | 336-812-3104
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Fax | 336-812-3105
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAWANA N PATTERSON
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Credential | DDS
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Telephone | 202-607-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 9248
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License Number State | NC
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