Provider Demographics
NPI:1841478872
Name:SPROUSE, RORY (DMD)
Entity type:Individual
Prefix:
First Name:RORY
Middle Name:
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 LECROY DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2222
Mailing Address - Country:US
Mailing Address - Phone:770-973-1380
Mailing Address - Fax:
Practice Address - Street 1:2231 ROBINSON RD NE STE 1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2289
Practice Address - Country:US
Practice Address - Phone:770-973-1380
Practice Address - Fax:770-973-1381
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice