Provider Demographics
NPI:1477886828
Name:PRATER, PHILLIP DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DOUGLAS
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 1:229 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2020
Mailing Address - Country:US
Mailing Address - Phone:740-622-5695
Mailing Address - Fax:740-622-0231
Practice Address - Street 1:229 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2020
Practice Address - Country:US
Practice Address - Phone:740-622-5695
Practice Address - Fax:740-622-0231
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0227971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice