Individual
DR. JONATHAN ROBERT PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S
Contact information
Practice address
24510 EASTEX FWY STE 110, KINGWOOD, TX 77339-2698
(281) 608-7535
(281) 608-7537
Mailing address
24510 HIGHWAY 59 N STE 110, KINGWOOD, TX 77339-2692
(281) 608-7535
(281) 608-7537
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30790
TX
1223P0221X
Pediatric Dentistry
Primary
30790
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357948401
—
TX
05
—
357948402
—
TX
Enumeration date
03/14/2013
Last updated
11/10/2018
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