Provider Demographics
NPI:1023265592
Name:DUFFY, PATRICK THOMAS (DDS,)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THOMAS
Last Name:DUFFY
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:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-1220
Mailing Address - Country:US
Mailing Address - Phone:715-634-2011
Mailing Address - Fax:715-634-1352
Practice Address - Street 1:10541 N RANCH RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6462
Practice Address - Country:US
Practice Address - Phone:715-634-2011
Practice Address - Fax:715-634-1352
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3762-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33494400Medicaid