Provider Demographics
NPI:1821198854
Name:SPRAGUE, LAURA IMMEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:IMMEL
Last Name:SPRAGUE
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 1:25500 RANCHO NIGUEL RD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7302
Mailing Address - Country:US
Mailing Address - Phone:949-425-0005
Mailing Address - Fax:949-425-0058
Practice Address - Street 1:25500 RANCHO NIGUEL RD
Practice Address - Street 2:SUITE #130
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-425-0005
Practice Address - Fax:949-425-0058
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist