Provider Demographics
NPI:1376646935
Name:DR RICHARD L SPARKS DDS, MSD, LTD
Entity Type:Organization
Organization Name:DR RICHARD L SPARKS DDS, MSD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, LTD
Authorized Official - Phone:602-993-8800
Mailing Address - Street 1:770 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5307
Mailing Address - Country:US
Mailing Address - Phone:602-993-8800
Mailing Address - Fax:602-993-3419
Practice Address - Street 1:770 E THUNDERBIRD RD
Practice Address - Street 2:SUITE C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5307
Practice Address - Country:US
Practice Address - Phone:602-993-8800
Practice Address - Fax:602-993-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty