Provider Demographics
NPI:1003685082
Name:SPRUELL, MARISSA (DDS)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SPRUELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 DELMAR BLVD APT 129
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2183
Mailing Address - Country:US
Mailing Address - Phone:863-289-0033
Mailing Address - Fax:
Practice Address - Street 1:2231 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2151
Practice Address - Country:US
Practice Address - Phone:636-287-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250296751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry