Active NPI
Isaac Edmundson Pratt, DDS,MSD
- Endodontics
- Mesa, AZ
National Provider Identifier
1548534035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D010237
- Practice address
- 1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046 - Phone
- (480) 376-0593
- NPI assigned
- Feb 29, 2012
- Last updated
- Feb 27, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D010237 | AZ | Primary |
Addresses
Primary practice location
1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046
Mailing address
4304 E Campbell Ave Apt 2009
Phoenix, AZ 85018-3774
Phone (718) 844-8443
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 |
|---|---|---|---|
| D010237 | AZ | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mesa Valley Modern Dentistry, LLP | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1548534035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4304 E CAMPBELL AVE APT 2009",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183774",
"telephone_number": "718-844-8443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1712 S COUNTRY CLUB DR STE 104",
"city": "MESA",
"state": "AZ",
"postal_code": "852106046",
"telephone_number": "480-376-0593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATT",
"first_name": "ISAAC",
"middle_name": "EDMUNDSON",
"name_prefix": "Dr.",
"credential": "DDS,MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-29",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "AZ",
"license": "D010237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
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- Roopashree Prabhushankar, MD
- Jesus Prado, DNP, PMHNP-BC
- Deepa Prasad, MD
- Kirstyn Prater, DNP
- Eileen S Pratte, OTR/L
- Prayer Changes Things Community Health
- Shay Preble
- Precision Anesthesia LLC
- Precision Integrative Specialists & Oncology LLC (Preferred Integrative Specialists & Oncology LLC)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.