Provider Demographics
NPI:1710185848
Name:PRATT, STEPHEN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
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 1:822 W 1500 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2994
Mailing Address - Country:US
Mailing Address - Phone:801-592-6572
Mailing Address - Fax:
Practice Address - Street 1:4501 E SNIDER DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7604
Practice Address - Country:US
Practice Address - Phone:907-376-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76520721223G0001X
AK12371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice