Individual
PHILLIP R PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2705 S BERKLEY, BUILDING 2 SUITE B, KOKOMO, IN 46902-8007
(765) 453-2267
(765) 453-1150
Mailing address
2705 S BERKLEY, BUILDING 2 SUITE B, KOKOMO, IN 46902-8007
(765) 453-2267
(765) 453-1150
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6519
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6519
DENTAL LICENSE
IN
Enumeration date
11/14/2006
Last updated
07/08/2007
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