Provider Demographics
NPI:1851450860
Name:PRATO, ESPERANZA MENDOZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESPERANZA
Middle Name:MENDOZA
Last Name:PRATO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8808
Mailing Address - Country:US
Mailing Address - Phone:337-437-7107
Mailing Address - Fax:337-437-7141
Practice Address - Street 1:2816 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8808
Practice Address - Country:US
Practice Address - Phone:337-437-7107
Practice Address - Fax:337-437-7141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH4597OtherBCBS ID #