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General NPI Number Information
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NPI Number | 1760768865
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Entity Type | Organization
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Legal Business Name | BRANDI PRATHER DMD
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 47 SARAHS LN
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City | SOMERSET
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State | KY
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Zip | 42503-2789
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Country | US
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Telephone | 606-679-1333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 224
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City | SOMERSET
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State | KY
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Zip | 42502-0224
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Country | US
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Telephone | 606-679-1333
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Fax |
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. BRANDI PRATHER
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Credential | DMD
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Telephone | 606-679-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8103
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License Number State | KY
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