Provider Demographics
NPI:1821745506
Name:BRAR, PRATEEK SOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRATEEK
Middle Name:SOOD
Last Name:BRAR
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 1:1871 PETITE SYRAH LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6684
Mailing Address - Country:US
Mailing Address - Phone:209-617-4193
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3124
Practice Address - Country:US
Practice Address - Phone:530-564-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty