MEDICARE: DR. LAURA IMMEL SPRAGUE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	43977	CA

General Provider Information

NPI Number	:	1821198854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA IMMEL SPRAGUE DDS

Provider Business Mailing Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	SUITE #130
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-425-0005
Fax Number	:	949-425-0058

Provider Business Practice Location Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	SUITE #130
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-425-0005
Fax Number	:	949-425-0058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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