Provider Demographics
NPI:1972581601
Name:DECILLA, PATRICIA LUCY (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LUCY
Last Name:DECILLA
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 1:1304 15TH ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1809
Mailing Address - Country:US
Mailing Address - Phone:310-394-5879
Mailing Address - Fax:310-394-8438
Practice Address - Street 1:1304 15TH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1809
Practice Address - Country:US
Practice Address - Phone:310-394-5879
Practice Address - Fax:310-394-8438
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice