Provider Demographics
NPI:1871505289
Name:SPRAGUE, RICHARD EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:SPRAGUE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 380
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6818
Mailing Address - Country:US
Mailing Address - Phone:424-653-9729
Mailing Address - Fax:833-786-1255
Practice Address - Street 1:415 N CRESCENT DR STE 380
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6818
Practice Address - Country:US
Practice Address - Phone:424-653-9729
Practice Address - Fax:833-786-1255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics