Provider Demographics
NPI:1659489003
Name:SPRATTLING, JACHELLE A G (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACHELLE
Middle Name:A G
Last Name:SPRATTLING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JACHELLE
Other - Middle Name:A
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1522
Mailing Address - Country:US
Mailing Address - Phone:843-752-7655
Mailing Address - Fax:843-752-4500
Practice Address - Street 1:203 S MARION ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1522
Practice Address - Country:US
Practice Address - Phone:843-752-7655
Practice Address - Fax:843-752-4500
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice