Provider Demographics
NPI:1548678832
Name:PATTERSON, LACY R (DMD)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-1152
Mailing Address - Country:US
Mailing Address - Phone:940-766-6306
Mailing Address - Fax:
Practice Address - Street 1:120 S CENTRAL EXPY STE 103
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3753
Practice Address - Country:US
Practice Address - Phone:214-618-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29728122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist