MEDICARE: DR. STEPHANIE ELIZABETH PATTERSON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DS044403	PA

General Provider Information

NPI Number	:	1053992297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ELIZABETH PATTERSON DMD

Provider Business Mailing Address
First Line	:	1202 ASHBOURNE RD
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2703
Country	:	US
Telephone Number	:	215-704-5263
Fax Number	:

Provider Business Practice Location Address
First Line	:	8127 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3530
Country	:	US
Telephone Number	:	215-844-1020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	01/08/2024

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