Provider Demographics
NPI:1649469867
Name:PATE, DELENA JANE (RDH)
Entity type:Individual
Prefix:
First Name:DELENA
Middle Name:JANE
Last Name:PATE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-7101
Mailing Address - Country:US
Mailing Address - Phone:843-680-0813
Mailing Address - Fax:843-335-6309
Practice Address - Street 1:645 S SEVENTH ST
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-7101
Practice Address - Country:US
Practice Address - Phone:843-680-0813
Practice Address - Fax:843-335-6309
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3498124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist