Provider Demographics
NPI:1871090860
Name:DYLAN PATRICK DDS, PLLC
Entity type:Organization
Organization Name:DYLAN PATRICK DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-363-3648
Mailing Address - Street 1:2660 BARTON CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7054
Mailing Address - Country:US
Mailing Address - Phone:903-363-3648
Mailing Address - Fax:
Practice Address - Street 1:419 W SW LOOP 323 STE 300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7062
Practice Address - Country:US
Practice Address - Phone:903-251-9292
Practice Address - Fax:903-207-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-07
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty