Provider Demographics
NPI:1336575273
Name:SONJA A. SPROUL, D.D.S., P.C.
Entity Type:Organization
Organization Name:SONJA A. SPROUL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPROUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-689-2001
Mailing Address - Street 1:51 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2077
Mailing Address - Country:US
Mailing Address - Phone:541-689-2001
Mailing Address - Fax:541-463-1263
Practice Address - Street 1:51 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2077
Practice Address - Country:US
Practice Address - Phone:541-689-2001
Practice Address - Fax:541-463-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty