=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023313897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY D PRATER DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2011
-----------------------------------------------------
Last Update Date | 01/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RR 1 BOX 8
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73741-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-852-3135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 1 BOX 8
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73741-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-852-3135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3481
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------