Provider Demographics
NPI:1124351358
Name:PATTISON, GORDON LEE III (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:LEE
Last Name:PATTISON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11859 WILSHIRE BLVD
Mailing Address - Street 2:STE. 550
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6616
Mailing Address - Country:US
Mailing Address - Phone:310-473-3800
Mailing Address - Fax:310-473-9107
Practice Address - Street 1:11859 WILSHIRE BLVD
Practice Address - Street 2:STE. 550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6616
Practice Address - Country:US
Practice Address - Phone:310-473-3800
Practice Address - Fax:310-473-9107
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics