Provider Demographics
NPI:1174542740
Name:PATTERSON, RANDAL PAUL (DMD)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:PAUL
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3035
Mailing Address - Country:US
Mailing Address - Phone:814-944-2802
Mailing Address - Fax:
Practice Address - Street 1:901 S LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3035
Practice Address - Country:US
Practice Address - Phone:814-944-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025267L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA203321OtherUPMC HEALTH PLAN
PA000672680OtherHIGHMARK BCBS
PA7008OtherGEISINGER HEALTH PLAN
PA001240351Medicaid
PA672680TW6Medicare ID - Type Unspecified
PA001240351Medicaid