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General NPI Number Information
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NPI Number | 1720972706
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Entity Type | Organization
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Legal Business Name | PRATHER DYNASTY LLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 202 S MAIN ST
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City | HUNTSVILLE
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State | MO
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Zip | 65259-1041
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Country | US
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Telephone | 660-277-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 502 EAGLE ST
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City | MOBERLY
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State | MO
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Zip | 65270-5579
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Country | US
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Telephone | 816-349-7082
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHANIEL PRATHER
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Credential | DDS
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Telephone | 816-349-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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