Provider Demographics
NPI:1679144497
Name:SPARKMAN, KRISTI BREANNE (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:BREANNE
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5527
Mailing Address - Country:US
Mailing Address - Phone:409-721-5212
Mailing Address - Fax:
Practice Address - Street 1:1512 S 21ST ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5527
Practice Address - Country:US
Practice Address - Phone:409-721-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice