1588929848 NPI number — DR. PATRICIA JORDAN FAST D.M.D.

Table of content: DR. PATRICIA JORDAN FAST D.M.D. (NPI 1588929848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588929848 NPI number — DR. PATRICIA JORDAN FAST D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAST
Provider First Name:
PATRICIA
Provider Middle Name:
JORDAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JORDAN
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588929848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 MOHAWK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-269-4266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 HERITAGE LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29505-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-665-4477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8068 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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