Individual
TIMOTHY SPROULS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5958
Mailing address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5958
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10345
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
471722800
MEDICAL ASST PROVIDER #
MN
Enumeration date
03/29/2006
Last updated
07/21/2022
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