Provider Demographics
NPI:1649356056
Name:SPARKS, RONALD A (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2817
Mailing Address - Country:US
Mailing Address - Phone:310-657-0674
Mailing Address - Fax:310-657-0235
Practice Address - Street 1:275 S ROBERTSON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2817
Practice Address - Country:US
Practice Address - Phone:310-657-0674
Practice Address - Fax:310-657-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice