MEDICARE: DR. BRIAN CHRISTOPHER PRATT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21738	TX

General Provider Information

NPI Number	:	1457471302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CHRISTOPHER PRATT D.D.S.

Provider Business Mailing Address
First Line	:	15260 HIGHWAY 105 W
Second Line	:	SUITE 222
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-5259
Country	:	US
Telephone Number	:	832-381-6724
Fax Number	:

Provider Business Practice Location Address
First Line	:	9816 MEMORIAL BLVD
Second Line	:	101
City	:	HUMBLE
State	:	TX
Zip	:	77338-4255
Country	:	US
Telephone Number	:	281-446-6527
Fax Number	:	281-446-3619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	03/05/2009

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