Provider Demographics
NPI:1639874696
Name:SPROUT PEDIATRIC DENTAL
Entity Type:Organization
Organization Name:SPROUT PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ROSALIE
Authorized Official - Last Name:SCHLOESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-253-0358
Mailing Address - Street 1:554 HAMLIN HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-9319
Mailing Address - Country:US
Mailing Address - Phone:267-324-7933
Mailing Address - Fax:
Practice Address - Street 1:387 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2005
Practice Address - Country:US
Practice Address - Phone:570-253-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental