Individual
DR. RICHARD E SPRAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15 W EXCEL, PETERSBURG, AK 99833
(907) 772-3320
(907) 772-3320
Mailing address
P O BOX 567, PETERSBURG, AK 99833
(907) 772-3320
(907) 772-3320
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AA367
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA367
STATE LICENSE NUMBER
AK
05
—
DDO 367
—
AK
Enumeration date
08/23/2006
Last updated
07/09/2007
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