Provider Demographics
NPI:1356425987
Name:THOMAS K SPARKMAN, DDS, PC
Entity type:Organization
Organization Name:THOMAS K SPARKMAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-396-8061
Mailing Address - Street 1:2472 JETT FERRY RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3040
Mailing Address - Country:US
Mailing Address - Phone:770-396-8061
Mailing Address - Fax:770-396-9489
Practice Address - Street 1:2472 JETT FERRY RD
Practice Address - Street 2:SUITE 430
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3040
Practice Address - Country:US
Practice Address - Phone:770-396-8061
Practice Address - Fax:770-396-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty