Timothy Michael Pratt, D.D.S.
Individual provider Active NPI General Practice Dentistry · Killbuck, OH
NPI 1720083645 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1720083645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 17685 (OH)
- Practice address
- 150 West Front St.
Killbuck, OH 44637-0459 - Phone
- (330) 276-3705
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220915000929 | OH | Order and Referring Only - Dentist |
4183009913 |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17685 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17685 | OH | Yes |
Addresses
Primary practice location
150 West Front St.
Killbuck, OH 44637-0459
Mailing address
8108 Private Road 340
Millersburg, OH 44654-9158
Phone (330) 674-0847
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0576612 | Medicaid | OH |
Other providers in Killbuck, OH
All providers in Killbuck, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.