Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401005701 | VA |
NPI | 1013338136 |
---|---|
Provider Name | Dr. Paul, Patterson |
First Address | Manassas, VA 20109-3406 |
Second Address | Manassas, VA 20109-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 16/12/2013 |