Active NPI
David Mark Prator Sr., DDS
- Dentist
- Wasilla, AK
National Provider Identifier
1205010246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 464
- Practice address
- 4501 E Snider Drive
Wasilla, AK 99654 - Phone
- (907) 376-8400
- Fax
- (907) 376-8402
- NPI assigned
- Dec 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 464 | AK | Primary |
| Dentist | 122300000X | 1118489 | TX |
Addresses
Primary practice location
4501 E Snider Drive
Wasilla, AK 99654
Mailing address
P O B 876869
Wasilla, AK 99687
Phone (907) 376-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD4640 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 464 | AK | MD | Chiropractor |
| 1118489 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198713600000",
"number": "1205010246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O B 876869",
"city": "WASILLA",
"state": "AK",
"postal_code": "99687",
"telephone_number": "907-376-8400",
"fax_number": "907-376-8402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 E SNIDER DRIVE",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-376-8400",
"fax_number": "907-376-8402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATOR",
"first_name": "DAVID",
"middle_name": "MARK",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-27",
"last_updated": "2007-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "464",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "1118489",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD4640",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.