Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DEN4050 | ME |
NPI | 1114052446 |
---|---|
Provider Name | Gregory Howard Sprague |
First Address | Topsham, ME 04086 |
Second Address | Topsham, ME 04086-1832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 20/09/2017 |