Provider Demographics
NPI:1174269856
Name:PATNOE PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:PATNOE PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATNOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-344-0788
Mailing Address - Street 1:1573 WASHINGTON ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2505
Mailing Address - Country:US
Mailing Address - Phone:304-344-0788
Mailing Address - Fax:
Practice Address - Street 1:1573 WASHINGTON ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2505
Practice Address - Country:US
Practice Address - Phone:304-344-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty