Basic Information
| Provider Information | |||||||||
| NPI: | 1811124126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.D.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4243 E 136TH AVE | ||||||||
| Address2: | SUITE 324 | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806026916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202741380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4243 E 136TH AVE | ||||||||
| Address2: | SUITE 324 | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806026916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202741380 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 06/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 905792 | CO | Y | Dental Providers | Dental Hygienist |
No ID Information.