MEDICARE: DR. RICHARD EDWARD SPRAGUE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	41129	CA

General Provider Information

NPI Number	:	1871505289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EDWARD SPRAGUE D.D.S.

Provider Business Mailing Address
First Line	:	415 N CRESCENT DR STE 380
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-6818
Country	:	US
Telephone Number	:	424-653-9729
Fax Number	:	833-786-1255

Provider Business Practice Location Address
First Line	:	415 N CRESCENT DR STE 380
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-6818
Country	:	US
Telephone Number	:	424-653-9729
Fax Number	:	833-786-1255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	03/19/2025

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