Provider Demographics
NPI:1932816618
Name:SPARROW DENTAL LLC
Entity Type:Organization
Organization Name:SPARROW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-822-6464
Mailing Address - Street 1:557 N 8TH PL
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-1029
Mailing Address - Country:US
Mailing Address - Phone:503-985-9719
Mailing Address - Fax:
Practice Address - Street 1:21319 SW SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9218
Practice Address - Country:US
Practice Address - Phone:503-822-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty