Provider Demographics
NPI:1134181399
Name:SPRUNG, CLIFFORD CARL (DDS)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:CARL
Last Name:SPRUNG
Suffix:
Gender:M
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:MERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53056-0003
Mailing Address - Country:US
Mailing Address - Phone:262-538-0892
Mailing Address - Fax:262-538-2695
Practice Address - Street 1:W28550 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:MERTON
Practice Address - State:WI
Practice Address - Zip Code:53056-0003
Practice Address - Country:US
Practice Address - Phone:262-538-0892
Practice Address - Fax:262-538-2695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice