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General NPI Number Information
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NPI Number | 1588805808
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Entity Type | Organization
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Legal Business Name | DR G SPRINKLE
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 511 BOULEVARD
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City | SALEM
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State | VA
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Zip | 24153-5032
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Country | US
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Telephone | 540-389-0330
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Fax | 540-387-0746
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Provider Business Mailing Address
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Address Line | 511 BOULEVARD
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City | SALEM
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State | VA
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Zip | 24153-5032
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Country | US
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Telephone | 540-389-0330
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Fax | 540-387-0746
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GRANT M SPRINKLE
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Credential | DDS
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Telephone | 540-389-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401003065
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401005779
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License Number State | VA
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