Provider Demographics
NPI:1699701771
Name:PASS-DUDLEY, PATRICIA (DDS)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:PASS-DUDLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 ML KING BLVD
Mailing Address - Street 2:PMB #387
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:770-207-5158
Mailing Address - Fax:770-207-5160
Practice Address - Street 1:516 GREAT OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-207-5158
Practice Address - Fax:770-207-5160
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice