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General NPI Number Information
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NPI Number | 1487123006
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Entity Type | Organization
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Legal Business Name | SUSAN PRATER KUDLATS, D.M.D, P.A.
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 12620 BEACH BLVD STE 18
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7130
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Country | US
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Telephone | 404-509-1292
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Fax |
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Provider Business Mailing Address
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Address Line | 12620 BEACH BLVD STE 18
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7130
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Country | US
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Telephone | 404-509-1292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN PRATER
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Credential |
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Telephone | 904-620-0404
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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 |
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License Number State |
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