Provider Demographics
NPI:1497825145
Name:SPARKS, DAVID MILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILTON
Last Name:SPARKS
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 1:1690 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-3317
Mailing Address - Country:US
Mailing Address - Phone:765-342-8435
Mailing Address - Fax:765-342-3561
Practice Address - Street 1:1690 S OHIO ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3317
Practice Address - Country:US
Practice Address - Phone:765-342-8435
Practice Address - Fax:765-342-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007066A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice