MEDICARE: FORREST JOHN PRATT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D010864	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184156127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORREST JOHN PRATT DMD

Provider Business Mailing Address
First Line	:	2979 W ELLIOT RD STE 4
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1641
Country	:	US
Telephone Number	:	480-775-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2979 W ELLIOT RD STE 4
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1641
Country	:	US
Telephone Number	:	480-775-1304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	08/08/2022

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Directions to “ FORREST JOHN PRATT DMD” Practice Location

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