Provider Demographics
NPI:1174771802
Name:SPROTT, SIOBHIAN MELINDA BACCHUS (DDS, MPA)
Entity type:Individual
Prefix:DR
First Name:SIOBHIAN
Middle Name:MELINDA BACCHUS
Last Name:SPROTT
Suffix:
Gender:F
Credentials:DDS, MPA
Other - Prefix:DR
Other - First Name:SIOBHIAN
Other - Middle Name:MELINDA
Other - Last Name:BACCHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MPA
Mailing Address - Street 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:3401 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-829-5437
Practice Address - Fax:202-829-9255
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18578871223P0221X
VA04014123181223P0221X
DCDEN10008551223P0221X
MD151121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037892500Medicaid