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General NPI Number Information
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NPI Number | 1407964059
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Entity Type | Organization
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Legal Business Name | MARC PATRICK ENTERPRISES PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1210 E WASHINGTON
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City | IDABEL
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State | OK
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Zip | 74745-9998
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Country | US
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Telephone | 580-286-4444
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Fax | 580-286-7632
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Provider Business Mailing Address
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Address Line | 1210 E WASHINGTON AVE
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City | IDABEL
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State | OK
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Zip | 74745-9998
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Country | US
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Telephone | 580-286-4444
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Fax | 580-286-7632
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC B PATRICK
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Credential | DDS
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Telephone | 580-286-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5579
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License Number State | OK
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