Individual
LOIS SPRAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2 RUBIN DR, RUSHVILLE, NY 14544-9681
(585) 554-4400
Mailing address
1950 HIMROD RD, PENN YAN, NY 14527-8730
(315) 536-8241
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
006009
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006009
LICENSE
NY
Enumeration date
04/17/2007
Last updated
07/08/2007
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