Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5372 | TN |
NPI | 1003891490 |
---|---|
Provider Name | Dr. Thomas Mitchell Prater |
First Address | Millington, TN 38054 |
Second Address | Millington, TN 38054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 24/03/2017 |