Provider Demographics
NPI:1710442728
Name:BEAU SPARKMAN D.D.S., P.A.
Entity Type:Organization
Organization Name:BEAU SPARKMAN D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-503-6262
Mailing Address - Street 1:104 W RAY FINE BLVD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5299
Mailing Address - Country:US
Mailing Address - Phone:918-503-6262
Mailing Address - Fax:
Practice Address - Street 1:400 S 18TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3942
Practice Address - Country:US
Practice Address - Phone:479-785-1419
Practice Address - Fax:479-785-4390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAU SPARKMAN, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental