Provider Demographics
NPI:1790831881
Name:SPROULL, SHELLEY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:N
Last Name:SPROULL
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 1:7915 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1443
Mailing Address - Country:US
Mailing Address - Phone:210-680-1550
Mailing Address - Fax:
Practice Address - Street 1:7915 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1443
Practice Address - Country:US
Practice Address - Phone:210-680-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice