Provider Demographics
NPI:1730203712
Name:PATAM, MARLICE ARCANGEL (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MARLICE
Middle Name:ARCANGEL
Last Name:PATAM
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:1115 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3435
Mailing Address - Country:US
Mailing Address - Phone:626-394-4946
Mailing Address - Fax:626-296-2779
Practice Address - Street 1:1115 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3435
Practice Address - Country:US
Practice Address - Phone:626-394-4946
Practice Address - Fax:626-296-2779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA427571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery