Provider Demographics
NPI:1336823798
Name:SPARKS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SPARKS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELENA
Authorized Official - Middle Name:EVANCHO
Authorized Official - Last Name:PARLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-956-7867
Mailing Address - Street 1:15039 JARRETTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-2405
Mailing Address - Country:US
Mailing Address - Phone:570-956-7867
Mailing Address - Fax:
Practice Address - Street 1:100 SPARKS VALLEY RD STE C
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9234
Practice Address - Country:US
Practice Address - Phone:410-771-8200
Practice Address - Fax:410-771-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty