Provider Demographics
NPI:1669150355
Name:SPROUT PEDIATRIC DENTAL
Entity type:Organization
Organization Name:SPROUT PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ROSALIE
Authorized Official - Last Name:SCHLOESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-253-0358
Mailing Address - Street 1:554 HAMLIN HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-9319
Mailing Address - Country:US
Mailing Address - Phone:570-253-0358
Mailing Address - Fax:570-352-3395
Practice Address - Street 1:1073 OAK ST STE D
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3716
Practice Address - Country:US
Practice Address - Phone:570-253-0358
Practice Address - Fax:570-352-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty