Provider Demographics
NPI:1164421152
Name:SPARKMAN, THOMAS K (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:SPARKMAN
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 1:2472 JETT FERRY RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3040
Mailing Address - Country:US
Mailing Address - Phone:770-396-8061
Mailing Address - Fax:770-396-9489
Practice Address - Street 1:2472 JETT FERRY RD
Practice Address - Street 2:SUITE 430
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3040
Practice Address - Country:US
Practice Address - Phone:770-396-8061
Practice Address - Fax:770-396-9489
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice