Provider Demographics
NPI:1265438626
Name:PATACCA, DONALD G (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:PATACCA
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 1:1600 E ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2549
Mailing Address - Country:US
Mailing Address - Phone:440-546-0330
Mailing Address - Fax:440-746-1147
Practice Address - Street 1:1600 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2549
Practice Address - Country:US
Practice Address - Phone:440-546-0330
Practice Address - Fax:440-746-1147
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-02-04
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
OH191111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice