1124125323 NPI number — MICHAEL D. SPRENG, DDS, INC.

Table of content: (NPI 1124125323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124125323 NPI number — MICHAEL D. SPRENG, DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D. SPRENG, DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124125323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 KATHERINE AVE STE A
Provider Second Line Business Mailing Address:
P.O. BOX 602
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44805-3692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-289-1813
Provider Business Mailing Address Fax Number:
419-281-8279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 KATHERINE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44805-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-289-1813
Provider Business Practice Location Address Fax Number:
419-281-8279
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRENG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-289-1813

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  16602 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com