MEDICARE: DR. ROBERT C PATTON III D.D.S.

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	2013016194	MO

General Provider Information

NPI Number	:	1518306216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C PATTON III D.D.S.

Provider Business Mailing Address
First Line	:	3005 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-844-4255
Fax Number	:	573-446-5118

Provider Business Practice Location Address
First Line	:	3005 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-844-4255
Fax Number	:	573-446-5118

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	05/27/2020

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