MEDICARE: DR. THOMAS K SPARKMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10176	GA

General Provider Information

NPI Number	:	1164421152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS K SPARKMAN D.D.S.

Provider Business Mailing Address
First Line	:	2472 JETT FERRY RD
Second Line	:	SUITE 430
City	:	DUNWOODY
State	:	GA
Zip	:	30338-3040
Country	:	US
Telephone Number	:	770-396-8061
Fax Number	:	770-396-9489

Provider Business Practice Location Address
First Line	:	2472 JETT FERRY RD
Second Line	:	SUITE 430
City	:	DUNWOODY
State	:	GA
Zip	:	30338-3040
Country	:	US
Telephone Number	:	770-396-8061
Fax Number	:	770-396-9489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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