Provider Demographics
NPI:1003891490
Name:PRATER, THOMAS MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:PRATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 INTEGRITY DRIVE
Mailing Address - Street 2:BLDG. S771
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38054
Mailing Address - Country:US
Mailing Address - Phone:901-874-5361
Mailing Address - Fax:
Practice Address - Street 1:5722 INTEGRITY DRIVE
Practice Address - Street 2:BLDG. S771
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist