Provider Demographics
NPI:1750623799
Name:SPARKS, ROBERT ANDREW (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7823
Mailing Address - Country:US
Mailing Address - Phone:660-216-2514
Mailing Address - Fax:
Practice Address - Street 1:11401 NALL AVE STE 102
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1850
Practice Address - Country:US
Practice Address - Phone:913-705-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty