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General NPI Number Information
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NPI Number | 1588859664
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Entity Type | Individual
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Provider Name | MISTI SPRING PRATT D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 79 W ALEXANDRINE ST 3RD FLOOR
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City | DETROIT
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State | MI
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Zip | 48201-2015
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Country | US
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Telephone | 313-833-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 7206 FIELDS DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-7756
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Country | US
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Telephone | 317-698-3029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12011063A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901020651
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License Number State | MI
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