Provider Demographics
NPI:1114764974
Name:MCDERMOTT, PATRICK JAMES (DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CEDAR LAKE PT
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4800
Mailing Address - Country:US
Mailing Address - Phone:732-779-3445
Mailing Address - Fax:
Practice Address - Street 1:3875 CONLON WAY STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9607
Practice Address - Country:US
Practice Address - Phone:262-697-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist