MEDICARE: DR. JACQUELINE NICOLE PATTERSON 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	1223G0001X	General Practice Dentistry	5804	NV
2	122300000X	Dentist	5804	NV

General Provider Information

NPI Number	:	1790939403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE NICOLE PATTERSON D.D.S.

Provider Business Mailing Address
First Line	:	2920 PLEASANT LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2253
Country	:	US
Telephone Number	:	702-336-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 MONTESSOURI ST STE 109
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3063
Country	:	US
Telephone Number	:	702-362-9353
Fax Number	:

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

Provider Enumeration Date	:	11/07/2008
Last Update Date	:	01/23/2025

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