Provider Demographics
NPI:1700058559
Name:SPARKS, DAWN ALLISON (DO)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ALLISON
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 KUKUI GROVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-977-2700
Mailing Address - Fax:808-241-7626
Practice Address - Street 1:4366 KUKUI GROVE ST STE 202
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-977-2700
Practice Address - Fax:808-241-7626
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14574207LP2900X
OH58.001510207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30227661Medicaid
VT1016792Medicaid
VT1016792Medicaid