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General NPI Number Information
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NPI Number | 1356777866
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Entity Type | Organization
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Legal Business Name | BEE SPARKS DENTAL LLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 2261 PYRAMID WAY 2
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City | SPARKS
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State | NV
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Zip | 89431-2189
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Country | US
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Telephone | 775-331-4456
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Fax | 775-331-0979
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Provider Business Mailing Address
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Address Line | 2261 PYRAMID WAY 2
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City | SPARKS
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State | NV
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Zip | 89431-2189
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Country | US
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Telephone | 775-331-4456
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Fax | 775-331-0979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN E EVANS
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Credential | DDS
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Telephone | 775-331-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5956
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License Number State | NV
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