1922135482 NPI number — CHRIS D PATTON DDS INC

Table of content: (NPI 1922135482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922135482 NPI number — CHRIS D PATTON DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRIS D PATTON DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALIFORNIA SMILES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922135482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3253 MOUNT TAMI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92111-4634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-560-1461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-427-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
619-427-7070

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  35442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35442 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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