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General NPI Number Information
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NPI Number | 1093268757
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Entity Type | Organization
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Legal Business Name | RICHARD E SPRAGUE, DDS, INC
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 416 N BEDFORD DR SUITE 103
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4322
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Country | US
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Telephone | 949-356-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 416 NORTH BEDFORD DRIVE SUITE 103
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4322
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Country | US
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Telephone | 949-356-2021
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RICHARD EDWARD SPRAGUE
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Credential | DDS
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Telephone | 949-356-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41129
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License Number State | CA
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