| NPI | 1962760439 |
|---|---|
| Doing Business As | SPROUT PEDIATRIC DENTISTRY, INC |
| Entity Type | Organization |
| Authorized Contact | SHUNDA L THOMPSON Owner 800-764-1829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 24833) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24833) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 23564) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2012-05-02 |