Healthcare Provider Details

I. General information

NPI: 1174680326
Provider Name (Legal Business Name): LARMAN WAYNE SPROUSE DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 CHEROKEE TRL
KNOXVILLE TN
37920-2205
US

IV. Provider business mailing address

1522 CHEROKEE TRAIL
KNOXVILLE TN
37950-9019
US

V. Phone/Fax

Practice location:
  • Phone: 865-549-5380
  • Fax:
Mailing address:
  • Phone: 865-549-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS0000003754
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: