Provider Demographics
NPI:1417043407
Name:PATTERSON, SHANNON P (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:P
Last Name:PATTERSON
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 1:615 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3724
Mailing Address - Country:US
Mailing Address - Phone:601-833-0746
Mailing Address - Fax:601-833-0894
Practice Address - Street 1:615 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3724
Practice Address - Country:US
Practice Address - Phone:601-833-0746
Practice Address - Fax:601-833-0894
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2957-961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice