MEDICARE: CHASE PATTON DDS LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1851099626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE PATTON DDS LLC

Provider Business Mailing Address
First Line	:	3005 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-875-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-875-7040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT CHARLES PATTON III
Credential	:	DDS
Telephone Number	:	573-818-4325

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	03/09/2023

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