Healthcare Provider Details

I. General information

NPI: 1871505289
Provider Name (Legal Business Name): RICHARD EDWARD SPRAGUE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 380
BEVERLY HILLS CA
90210-6818
US

IV. Provider business mailing address

415 N CRESCENT DR STE 380
BEVERLY HILLS CA
90210-6818
US

V. Phone/Fax

Practice location:
  • Phone: 424-653-9729
  • Fax: 833-786-1255
Mailing address:
  • Phone: 424-653-9729
  • Fax: 833-786-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number41129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: