Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23413 | CA |
NPI | 1083865745 |
---|---|
Provider Name | Alan Sproles |
First Address | Visalia, CA 93291-4119 |
Second Address | Visalia, CA 93291-4119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |