Provider Demographics
NPI:1821183013
Name:PRATTAO, ROSALIND PANICH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:PANICH
Last Name:PRATTAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ROSALIND
Other - Middle Name:
Other - Last Name:PANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1060 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE#E
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1864
Mailing Address - Country:US
Mailing Address - Phone:770-442-9300
Mailing Address - Fax:
Practice Address - Street 1:1060 CAMBRIDGE SQ
Practice Address - Street 2:SUITE#E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1864
Practice Address - Country:US
Practice Address - Phone:770-442-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist