Provider Demographics
NPI:1811147788
Name:PRATT, MICHAEL CLARK (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARK
Last Name:PRATT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2928
Mailing Address - Country:US
Mailing Address - Phone:859-338-8232
Mailing Address - Fax:859-402-1421
Practice Address - Street 1:1287 HALLWOOD DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-7370
Practice Address - Country:US
Practice Address - Phone:606-784-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8462122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist