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General NPI Number Information
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NPI Number | 1710442728
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Entity Type | Organization
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Legal Business Name | BEAU SPARKMAN D.D.S., P.A.
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 400 S 18TH ST
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City | FORT SMITH
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State | AR
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Zip | 72901-3942
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Country | US
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Telephone | 479-785-1419
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Fax | 479-785-4390
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Provider Business Mailing Address
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Address Line | 104 W RAY FINE BLVD UNIT 5
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City | ROLAND
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State | OK
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Zip | 74954-5299
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Country | US
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Telephone | 918-503-6262
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | BEAU E SPARKMAN
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Credential |
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Telephone | 918-503-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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