Provider Demographics
NPI:1124150354
Name:JOHN J. PATOCK, DDS, INC
Entity type:Organization
Organization Name:JOHN J. PATOCK, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-337-1807
Mailing Address - Street 1:1163 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3452
Mailing Address - Country:US
Mailing Address - Phone:614-337-1807
Mailing Address - Fax:614-337-0629
Practice Address - Street 1:1163 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3452
Practice Address - Country:US
Practice Address - Phone:614-337-1807
Practice Address - Fax:614-337-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019560261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental