Provider Demographics
NPI:1134659402
Name:SPARKS, CHRISTOPHER DAVID JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:SPARKS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 AVENTINE DR APT 305
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0319
Mailing Address - Country:US
Mailing Address - Phone:336-263-9027
Mailing Address - Fax:
Practice Address - Street 1:829 FLEMING ST STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3560
Practice Address - Country:US
Practice Address - Phone:828-692-3080
Practice Address - Fax:828-692-9564
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice