Provider Demographics
NPI:1215291836
Name:HART, PATRICK SHEAMUS (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SHEAMUS
Last Name:HART
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 1:12600 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2335
Mailing Address - Country:US
Mailing Address - Phone:703-491-4278
Mailing Address - Fax:
Practice Address - Street 1:12600 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2335
Practice Address - Country:US
Practice Address - Phone:703-491-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3551223X0400X
VA04014140691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics