Provider Demographics
NPI:1053752592
Name:PRATT, MICHAEL D (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:PRATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N YELM ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3001
Mailing Address - Country:US
Mailing Address - Phone:509-783-1000
Mailing Address - Fax:509-783-0806
Practice Address - Street 1:419 N YELM ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3001
Practice Address - Country:US
Practice Address - Phone:509-783-1000
Practice Address - Fax:509-783-0806
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60371021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist