Healthcare Provider Details

I. General information

NPI: 1841731957
Provider Name (Legal Business Name): CHRISTOPHER SPROTT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 N EAGLE RD
BOISE ID
83713-0997
US

IV. Provider business mailing address

6019 N EAGLE RD
BOISE ID
83713-0997
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-2777
  • Fax:
Mailing address:
  • Phone: 208-377-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD-5402-PE
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: