| NPI | 1669582813 |
|---|---|
| Former Legal Business Name | PHILLIP R PATE |
| Entity Type | Organization |
| Authorized Contact | MATTHEW D PATE Corporation President/Co Owner 765-453-2267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |