Provider Demographics
NPI:1760607196
Name:TERRY PRATT D.D.S., INC.
Entity Type:Organization
Organization Name:TERRY PRATT D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-522-7010
Mailing Address - Street 1:2217 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4410
Mailing Address - Country:US
Mailing Address - Phone:510-522-7010
Mailing Address - Fax:510-522-2654
Practice Address - Street 1:2217 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4410
Practice Address - Country:US
Practice Address - Phone:510-522-7010
Practice Address - Fax:510-522-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD207161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD20716OtherDENTAL LICENSE
CAD20716OtherDENTAL LICENSE