Active NPI
Terry Susette Patrick, RDH
- Dental Hygienist
- Fort Benning, GA
National Provider Identifier
1760929525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 020.010280
- Practice address
- 199 8TH Division Rd.
Salomon Dental Clinic
Fort Benning, GA 31905-7077 - Phone
- (706) 617-6851
- NPI assigned
- Jan 31, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020.010280 | IL | Primary |
Addresses
Primary practice location
199 8TH Division Rd.
Salomon Dental Clinic
Fort Benning, GA 31905-7077
Mailing address
5264 10TH Armored Loop
Fpo, AP 31905-7077
Phone (773) 209-4832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020.010280 | IL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485820800000",
"number": "1760929525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "5264 10TH ARMORED LOOP",
"city": "FPO",
"state": "AP",
"postal_code": "319057077",
"telephone_number": "773-209-4832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "199 8TH DIVISION RD.",
"address_2": "SALOMON DENTAL CLINIC",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "319057077",
"telephone_number": "706-617-6851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATRICK",
"first_name": "TERRY",
"middle_name": "SUSETTE",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-31",
"last_updated": "2017-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IL",
"license": "020.010280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Benning, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.