=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427222611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD A. PATTERSON, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 BLUE RIDGE RD STE G10
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-781-3862
-----------------------------------------------------
Fax | 919-781-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 BLUE RIDGE RD STE G10
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-781-3862
-----------------------------------------------------
Fax | 919-781-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD ANTHONY PATTERSON
-----------------------------------------------------
Credential | D. D. S.
-----------------------------------------------------
Telephone | 919-781-3862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8066
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------