Provider Demographics
NPI:1356445589
Name:SPRAKER, MICHAEL W (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:SPRAKER
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:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:RURAL RETREAT
Mailing Address - State:VA
Mailing Address - Zip Code:24368-0377
Mailing Address - Country:US
Mailing Address - Phone:276-686-4211
Mailing Address - Fax:
Practice Address - Street 1:7061 WEST LEE HWY
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368
Practice Address - Country:US
Practice Address - Phone:276-686-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice