MEDICARE: DR. MATTHEW WARDEN SPROWLS D.D.S. M.S.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	21552	OH

General Provider Information

NPI Number	:	1972679397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW WARDEN SPROWLS D.D.S. M.S.D.

Provider Business Mailing Address
First Line	:	3168 MCLEAN RD
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-4766
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-5155
Country	:	US
Telephone Number	:	513-424-1296
Fax Number	:	513-424-6995

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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