Provider Demographics
NPI:1710035852
Name:PRATT, JOEL W (DDS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:W
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 1:102 S 17TH ST
Mailing Address - Street 2:P.O. BOX 188
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-1631
Mailing Address - Country:US
Mailing Address - Phone:660-947-3036
Mailing Address - Fax:660-947-7706
Practice Address - Street 1:102 S 17TH ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:63565-1631
Practice Address - Country:US
Practice Address - Phone:660-947-3036
Practice Address - Fax:660-947-7706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0127381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice