Healthcare Provider Details

I. General information

NPI: 1710539937
Provider Name (Legal Business Name): M. PRATT, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10049 MANCHESTER RD
SAINT LOUIS MO
63122-1825
US

IV. Provider business mailing address

10049 MANCHESTER RD
SAINT LOUIS MO
63122-1825
US

V. Phone/Fax

Practice location:
  • Phone: 314-671-4019
  • Fax: 314-671-4018
Mailing address:
  • Phone: 314-671-4019
  • Fax: 314-671-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAREN L PRATT
Title or Position: PEDIATRIC DENTIST
Credential: DDS, MS
Phone: 314-671-4019