Provider Demographics
NPI:1457991515
Name:SPROUSE, JEREMY CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CHARLES
Last Name:SPROUSE
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 1:1206 JACKSON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3067
Mailing Address - Country:US
Mailing Address - Phone:404-680-0393
Mailing Address - Fax:
Practice Address - Street 1:1005 DR. D.B TODD JR. BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3720
Practice Address - Country:US
Practice Address - Phone:615-327-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist