Provider Demographics
NPI:1518942101
Name:SPRAGUE, PHILIP R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
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 1:5115 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1850
Mailing Address - Country:US
Mailing Address - Phone:419-843-4228
Mailing Address - Fax:
Practice Address - Street 1:5860 ALEXIS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2347
Practice Address - Country:US
Practice Address - Phone:419-882-7187
Practice Address - Fax:419-882-3165
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH211661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry