Provider Demographics
NPI:1174640817
Name:PRATT, JUDITH ABOSAMRA (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ABOSAMRA
Last Name:PRATT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:ABOSAMRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4512 POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4124
Mailing Address - Country:US
Mailing Address - Phone:401-884-2190
Mailing Address - Fax:
Practice Address - Street 1:4512 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4124
Practice Address - Country:US
Practice Address - Phone:401-884-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI25291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8165-2OtherBLUE CROSS DENTAL