Provider Demographics
NPI:1275894941
Name:SPRAGUE, TAYLOR J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:J
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 1:8701 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8852
Mailing Address - Country:US
Mailing Address - Phone:918-250-9528
Mailing Address - Fax:918-250-9529
Practice Address - Street 1:8701 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8852
Practice Address - Country:US
Practice Address - Phone:918-250-9528
Practice Address - Fax:918-250-9529
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist