Provider Demographics
NPI:1588805808
Name:DR G SPRINKLE
Entity Type:Organization
Organization Name:DR G SPRINKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPRINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-389-0330
Mailing Address - Street 1:511 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5032
Mailing Address - Country:US
Mailing Address - Phone:540-389-0330
Mailing Address - Fax:540-387-0746
Practice Address - Street 1:511 BOULEVARD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5032
Practice Address - Country:US
Practice Address - Phone:540-389-0330
Practice Address - Fax:540-387-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005779261QD0000X
VA0401003065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental