Provider Demographics
NPI:1326028242
Name:PATTERSON, MICHAEL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S DUQUESNE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1531
Mailing Address - Country:US
Mailing Address - Phone:417-782-0400
Mailing Address - Fax:417-206-6230
Practice Address - Street 1:2700 MCCLELLAND BLVD
Practice Address - Street 2:BLDG. A, STE. 102
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1623
Practice Address - Country:US
Practice Address - Phone:417-782-0400
Practice Address - Fax:417-206-6230
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010206171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice