Susan Prater Kudlats, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN21768 Issued in FL

Practice address

12620 Beach Blvd
Suite 18
Jacksonville, FL 32246

Phone

(706) 738-6516

Fax

(706) 262-6518

NPI assigned

Jul 7, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Susan Prater Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 21, 2016 through Jan 21, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Susan Prater Kudlats, D.M.D, P.a.

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1487123006
  NPD (past)
• Augusta Dental Associates,LLC

  • General Practice Dentistry
  • Augusta, GA
  • NPI 1386650836
  NPD (past)
• P L Hooton DMD PC

  • Dentist
  • Saint Marys, GA
  • NPI 1417068164
  NPD (past)
• Sharp Smiles, LLC

  • Dental Clinic/Center
  • Saint Marys, GA
  • NPI 1629552377
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1689803041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 SPANISH CREEK DRIVE",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "706-738-6516",
            "fax_number": "706-262-6518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 BEACH BLVD",
            "address_2": "SUITE 18",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32246",
            "telephone_number": "706-738-6516",
            "fax_number": "706-262-6518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATER KUDLATS",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-07",
        "last_updated": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "PRATER",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leticia Prado
• Sanket Prajapati, PHARMD
• Kwasi Prakah-Asante, MD
• Swati Prasad, MD, MBBS
• Kyle Praschan
• Ryan Prater, DPT
• Shawn Gregory Prather, LMT, RBT
• Sarah R Pratico, DNP, APRN, FNP-BC
• Joanne Landrum Pratt-Dannals, MA LMFT CLINICAL MEM
• Amanda Rene Pratt, PT, DPT

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.