MEDICARE: SOPHIE LOUISE PATENAUDE 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	122300000X	Dentist	DE60504242	WA

General Provider Information

NPI Number	:	1336880624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE LOUISE PATENAUDE DMD

Provider Business Mailing Address
First Line	:	1953 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2558
Country	:	US
Telephone Number	:	360-876-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1953 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2558
Country	:	US
Telephone Number	:	360-876-6211
Fax Number	:

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

Provider Enumeration Date	:	04/02/2022
Last Update Date	:	04/16/2025

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