=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518260389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNT VERNON DENTAL-RICHARD M. SPRANG, DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2010
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 S MULBERRY ST
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43050-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-392-1871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 S MULBERRY ST
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43050-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-392-1871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD M SPRANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 740-392-1871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30022387
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------