Provider Demographics
NPI:1316123235
Name:PATTON, HAL R (DDS)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:R
Last Name:PATTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 TROY RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2590
Mailing Address - Country:US
Mailing Address - Phone:618-656-2277
Mailing Address - Fax:618-656-7732
Practice Address - Street 1:1403 TROY RD STE B
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2590
Practice Address - Country:US
Practice Address - Phone:618-656-2277
Practice Address - Fax:618-656-7732
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist