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General NPI Number Information
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NPI Number | 1306235619
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Entity Type | Organization
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Legal Business Name | RANDON S. PRATHER, D.M.D., P.S.C.
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Dates
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Enumeration Date | 01/11/2015
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Last Update Date | 01/11/2015
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Provider Practice Location Address
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Address Line | 1301 OLIVE ST
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City | BENTON
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State | KY
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Zip | 42025-1640
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Country | US
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Telephone | 270-527-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 OLIVE ST PO BOX 585
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City | BENTON
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State | KY
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Zip | 42025-1640
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Country | US
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Telephone | 270-527-1479
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Fax | 270-527-3192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDON SCOTT PRATHER
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Credential | D.M.D.
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Telephone | 270-527-1479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9492
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License Number State | KY
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