Provider Demographics
NPI:1093734592
Name:SPARKS, DAVID EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ZEHNER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9263
Mailing Address - Country:US
Mailing Address - Phone:724-357-8354
Mailing Address - Fax:
Practice Address - Street 1:116 6TH ST
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:PA
Practice Address - Zip Code:15728-1189
Practice Address - Country:US
Practice Address - Phone:724-245-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS19497L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice