Marlice Arcangel Patam, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

42757 Issued in CA

Practice address

1115 Montrose Ave
South Pasadena, CA 91030-3435

Phone

(626) 394-4946

Fax

(626) 296-2779

NPI assigned

Mar 16, 2007

Last updated

Sep 23, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpatam19307@direct.uclahealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A. Tsibel Dental Corp

  dba Long Beach Family Dentist

  • Dental Clinic/Center
  • Long Beach, CA
  • NPI 1447012653
  NPD
• Arkady S. Tsibel Dental Corp

  dba Walnut Hill Dental

  • Dental Clinic/Center
  • Pasadena, CA
  • NPI 1013779222
  NPD
• Tsibel Dental Practice Inc.

  dba Dental Specialist of Riverside

  • Dental Clinic/Center
  • Riverside, CA
  • NPI 1871355081
  NPD
• Leon D. Roisman, D.M.D., Inc.

  dba Dental Plus - A Dental Group of Leon D. Roisman, D.M.D., Inc.

  • Prosthodontics
  • Pasadena, CA
  • NPI 1912046871

  Oral and Maxillofacial Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1730203712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 MONTROSE AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910303435",
            "telephone_number": "626-394-4946",
            "fax_number": "626-296-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 MONTROSE AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910303435",
            "telephone_number": "626-394-4946",
            "fax_number": "626-296-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATAM",
        "first_name": "MARLICE",
        "middle_name": "ARCANGEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "42757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sohyun Stephanie Park, DMD
• Alvin Parker, AA
• Mary M Parr, L.AC
• Robert John Parsons, PH.D.
• Louis Steven Pastis, D.C.
• Hetal Patel, DC
• Path to Growth Counseling Inc.
• Katharine Lynn Pattee
• Alexis Paul, PSYD
• Demetri Pearson

• Oral and Maxillofacial Surgery (Dentist) in South Pasadena, CA
• Providers in South Pasadena, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.