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General NPI Number Information
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NPI Number | 1669150355
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Entity Type | Organization
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Legal Business Name | SPROUT PEDIATRIC DENTAL
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1073 OAK ST STE D
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City | PITTSTON
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State | PA
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Zip | 18640-3716
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Country | US
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Telephone | 570-253-0358
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Fax | 570-352-3395
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Provider Business Mailing Address
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Address Line | 554 HAMLIN HWY
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City | LAKE ARIEL
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State | PA
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Zip | 18436-9319
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Country | US
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Telephone | 570-253-0358
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Fax | 570-352-3395
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE ROSALIE SCHLOESSER
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Credential | DMD
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Telephone | 570-253-0358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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