Provider Demographics
NPI:1306866371
Name:SPARKS, GEOFF
Entity Type:Individual
Prefix:
First Name:GEOFF
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 HEFNER POINTE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5066
Mailing Address - Country:US
Mailing Address - Phone:405-947-1526
Mailing Address - Fax:405-946-2460
Practice Address - Street 1:10914 HEFNER POINTE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5066
Practice Address - Country:US
Practice Address - Phone:405-947-1526
Practice Address - Fax:405-946-2460
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics