1033172671 NPI number — SANDRA PATTERSON DMD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033172671 NPI number — SANDRA PATTERSON DMD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PATTERSON

Provider First Name:

SANDRA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DMD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

CROYLE

Provider Other First Name:

SANDRA

Provider Other Middle Name:

LYNN CROYLE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1033172671

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

926 GREAT POND DR

Provider Second Line Business Mailing Address:

SUITE 2003

Provider Business Mailing Address City Name:

ALTAMONTE SPRINGS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

32714-7244

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

407-772-5124

Provider Business Mailing Address Fax Number:

407-788-3572

Provider First Line Business Practice Location Address:

129 HILLCREST SHOPPING CTR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LOWER BURRELL

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15068-3504

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-337-7800

Provider Business Practice Location Address Fax Number:

724-337-9982

Provider Enumeration Date:

04/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1223X0400X , with the licence number:  DS035986 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1009833460010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1009833460008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".