Provider Demographics
NPI:1154427979
Name:NILAND, PATRICK A (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:NILAND
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6102
Mailing Address - Country:US
Mailing Address - Phone:208-467-5259
Mailing Address - Fax:208-466-3741
Practice Address - Street 1:1609 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6102
Practice Address - Country:US
Practice Address - Phone:208-467-5259
Practice Address - Fax:208-466-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3235OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics