Provider Demographics
NPI:1417396763
Name:PRATT, JASON T (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:PRATT
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 1:700 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5927
Mailing Address - Country:US
Mailing Address - Phone:910-692-7761
Mailing Address - Fax:910-692-7471
Practice Address - Street 1:700 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5927
Practice Address - Country:US
Practice Address - Phone:910-692-7761
Practice Address - Fax:910-692-7471
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice