Provider Demographics
NPI:1174811913
Name:MENNING, PATRICIA (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:MENNING
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 1:24150 US-290
Mailing Address - Street 2:#100
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:281-758-1555
Mailing Address - Fax:
Practice Address - Street 1:24150 HIGHWAY 290
Practice Address - Street 2:SUITE 100
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1024
Practice Address - Country:US
Practice Address - Phone:281-758-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284449003Medicaid