Provider Demographics
NPI:1265451447
Name:SPARTA DENTAL DESIGNS
Entity Type:Organization
Organization Name:SPARTA DENTAL DESIGNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TIRPACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-729-2113
Mailing Address - Street 1:16 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3512
Mailing Address - Country:US
Mailing Address - Phone:973-729-2113
Mailing Address - Fax:973-729-2110
Practice Address - Street 1:16 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3512
Practice Address - Country:US
Practice Address - Phone:973-729-2113
Practice Address - Fax:973-729-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013058001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty