Provider Demographics
NPI:1376636340
Name:PRATHER, THOMAS LELAND (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LELAND
Last Name:PRATHER
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 1:1941 W BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6027
Mailing Address - Country:US
Mailing Address - Phone:765-453-6200
Mailing Address - Fax:
Practice Address - Street 1:1941 W BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6027
Practice Address - Country:US
Practice Address - Phone:765-453-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120080231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice