Provider Demographics
NPI:1770329468
Name:PATRICK, ANNA GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GRACE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 POMEROY DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9740
Mailing Address - Country:US
Mailing Address - Phone:919-605-6079
Mailing Address - Fax:
Practice Address - Street 1:1732 OLD MORGANTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5185
Practice Address - Country:US
Practice Address - Phone:910-519-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist