Provider Demographics
NPI:1396915534
Name:PRATHER, BRENTON LYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:LYLE
Last Name:PRATHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4564
Mailing Address - Country:US
Mailing Address - Phone:870-862-4543
Mailing Address - Fax:870-862-4542
Practice Address - Street 1:347 W OAK ST STE B
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4564
Practice Address - Country:US
Practice Address - Phone:870-862-4543
Practice Address - Fax:870-862-4542
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice