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General NPI Number Information
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NPI Number | 1225168156
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Entity Type | Organization
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Legal Business Name | SPRAGUE, PACKHAM & PIZZA DENTAL CORPORATION
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 4027 MISSION OAKS BLVD
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City | CAMARILLO
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State | CA
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Zip | 93012-5156
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Country | US
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Telephone | 805-484-1022
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Fax | 805-484-3221
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Provider Business Mailing Address
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Address Line | 4027 MISSION OAKS BLVD
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City | CAMARILLO
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State | CA
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Zip | 93012-5156
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Country | US
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Telephone | 805-484-1022
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Fax | 805-484-3221
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Authorized Official
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Title or Position | DENTIST CEO
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Name | DR. ROBERT W SPRAGUE
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Credential | DDS
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Telephone | 805-484-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29105
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License Number State | CA
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