Provider Demographics
NPI:1467550566
Name:SPARKS, JULIAN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:F
Last Name:SPARKS
Suffix:
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35747-0069
Mailing Address - Country:US
Mailing Address - Phone:256-728-2231
Mailing Address - Fax:256-728-2232
Practice Address - Street 1:114 EMMETT AYERS RD
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747-0069
Practice Address - Country:US
Practice Address - Phone:256-728-2231
Practice Address - Fax:256-728-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL-30151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice