Provider Demographics
NPI:1588771703
Name:PATTERSON, TRACY R (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WALLIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5403
Mailing Address - Country:US
Mailing Address - Phone:781-862-2625
Mailing Address - Fax:781-862-9169
Practice Address - Street 1:1 WALLIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5403
Practice Address - Country:US
Practice Address - Phone:781-862-2625
Practice Address - Fax:781-862-9169
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics