Healthcare Provider Details

I. General information

NPI: 1396512166
Provider Name (Legal Business Name): BUMBLE BEE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W. FIRST ST.
DUMAS TX
79029
US

IV. Provider business mailing address

115 W. FIRST ST.
DUMAS TX
79029
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-9732
  • Fax: 806-329-0244
Mailing address:
  • Phone: 806-355-9732
  • Fax: 806-329-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOHN SPARKMAN
Title or Position: OWNER
Credential:
Phone: 806-355-9732