Provider Demographics
NPI:1194869420
Name:PATTERSON, RICHARD A (DDSMS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 SMOKERISE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1858
Mailing Address - Country:US
Mailing Address - Phone:919-610-7442
Mailing Address - Fax:
Practice Address - Street 1:2801 BLUE RIDGE RD STE G10
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6474
Practice Address - Country:US
Practice Address - Phone:919-781-3862
Practice Address - Fax:919-781-7988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80661223G0001X, 1223X0400X
TX326991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty