Provider Demographics
NPI:1447810809
Name:PATCHETT, DREW (DMD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:PATCHETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 HUNTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1455
Mailing Address - Country:US
Mailing Address - Phone:334-790-7524
Mailing Address - Fax:
Practice Address - Street 1:7731 KINGSTON PIKE STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5519
Practice Address - Country:US
Practice Address - Phone:865-525-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN109791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty