Provider Demographics
NPI:1154319267
Name:SPRICK, KATHY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:SPRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2242
Mailing Address - Country:US
Mailing Address - Phone:541-664-3335
Mailing Address - Fax:541-664-2077
Practice Address - Street 1:21 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2242
Practice Address - Country:US
Practice Address - Phone:541-664-3335
Practice Address - Fax:541-664-2077
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD63351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice