Provider Demographics
NPI:1588874580
Name:PATTERSON, RANDAL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:LEE
Last Name:PATTERSON
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 1:4900 TIMBER EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9471
Mailing Address - Country:US
Mailing Address - Phone:330-659-4193
Mailing Address - Fax:
Practice Address - Street 1:1414 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6720
Practice Address - Country:US
Practice Address - Phone:440-886-2177
Practice Address - Fax:440-886-2240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0161561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice