Provider Demographics
NPI:1407443286
Name:SPRINKLE, CARISSA FITCH (DDS)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:FITCH
Last Name:SPRINKLE
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 1:119 E GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4629
Mailing Address - Country:US
Mailing Address - Phone:434-609-3334
Mailing Address - Fax:
Practice Address - Street 1:3709 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6902
Practice Address - Country:US
Practice Address - Phone:434-385-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014169601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice