Provider Demographics
NPI:1528174687
Name:ANNA PATRAS DMD PA
Entity type:Organization
Organization Name:ANNA PATRAS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-729-5900
Mailing Address - Street 1:133 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4702
Mailing Address - Country:US
Mailing Address - Phone:732-826-1154
Mailing Address - Fax:
Practice Address - Street 1:21 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1808
Practice Address - Country:US
Practice Address - Phone:973-729-5900
Practice Address - Fax:973-729-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02246400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty