Healthcare Provider Details

I. General information

NPI: 1831206226
Provider Name (Legal Business Name): RICHARD E SPRAGUE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W EXCEL
PETERSBURG AK
99833
US

IV. Provider business mailing address

P O BOX 567
PETERSBURG AK
99833
US

V. Phone/Fax

Practice location:
  • Phone: 907-772-3320
  • Fax: 907-772-3320
Mailing address:
  • Phone: 907-772-3320
  • Fax: 907-772-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAA367
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: