Provider Demographics
NPI:1689803041
Name:PRATER KUDLATS, SUSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PRATER KUDLATS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:PRATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:221 SPANISH CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081
Mailing Address - Country:US
Mailing Address - Phone:706-738-6516
Mailing Address - Fax:706-262-6518
Practice Address - Street 1:12620 BEACH BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:706-738-6516
Practice Address - Fax:706-262-6518
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist