Provider Demographics
NPI:1003010612
Name:SPRAGUE, PATRICK EARLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EARLE
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CANAAN ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-9734
Mailing Address - Country:US
Mailing Address - Phone:540-743-5132
Mailing Address - Fax:
Practice Address - Street 1:4 CANAAN ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-9734
Practice Address - Country:US
Practice Address - Phone:540-743-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice