Provider Demographics
NPI:1669030623
Name:SPARKS, SHARONDA (RDH)
Entity Type:Individual
Prefix:MS
First Name:SHARONDA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7832 ROLLING VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3635
Mailing Address - Country:US
Mailing Address - Phone:443-804-7489
Mailing Address - Fax:
Practice Address - Street 1:5632 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2737
Practice Address - Country:US
Practice Address - Phone:410-435-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6018124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist