Provider Demographics
NPI:1801178256
Name:SPARKS, JOSHUA THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:THOMAS
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 1:3740 S 14TH STREET
Mailing Address - Street 2:USA DENTAL HEALTH ACTIVITY
Mailing Address - City:JOINT BASE LEWIS-MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433
Mailing Address - Country:US
Mailing Address - Phone:253-967-5271
Mailing Address - Fax:
Practice Address - Street 1:BLDG 38801, ACADEMIC DRIVE
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-5738
Practice Address - Fax:706-787-2072
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60244154122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist