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General NPI Number Information
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NPI Number | 1467693069
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Entity Type | Organization
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Legal Business Name | BRIAN C. PRATT, DDS, PA
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 15260 HIGHWAY 105 W STE 222
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City | MONTGOMERY
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State | TX
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Zip | 77356-5259
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Country | US
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Telephone | 832-381-6724
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Fax |
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Provider Business Mailing Address
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Address Line | 15260 HIGHWAY 105 W STE 222
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City | MONTGOMERY
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State | TX
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Zip | 77356-5259
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Country | US
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Telephone | 832-381-6724
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRIAN CHRISTOPHER PRATT
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Credential | D.D.S.
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Telephone | 832-381-6724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 21777
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21738
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License Number State | TX
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