Provider Demographics
NPI:1548272347
Name:PATE, RICHARD L (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PATE
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 1:2292 CHAMBLISS AVE NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3862
Mailing Address - Country:US
Mailing Address - Phone:423-476-8831
Mailing Address - Fax:423-476-5525
Practice Address - Street 1:2292 CHAMBLISS AVE NW
Practice Address - Street 2:SUITE D
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3862
Practice Address - Country:US
Practice Address - Phone:423-476-8831
Practice Address - Fax:423-476-5525
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000044221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice