Provider Demographics
NPI:1912108127
Name:PRATT, WILLIAM CHAUNCEY (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAUNCEY
Last Name:PRATT
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 1:1450 10TH ST
Mailing Address - Street 2:306
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2857
Mailing Address - Country:US
Mailing Address - Phone:310-451-5533
Mailing Address - Fax:310-458-9107
Practice Address - Street 1:1450 10TH ST
Practice Address - Street 2:306
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2857
Practice Address - Country:US
Practice Address - Phone:310-451-5533
Practice Address - Fax:310-458-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice