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General NPI Number Information
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NPI Number | 1811571631
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Entity Type | Organization
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Legal Business Name | SPARKS MODERN DENTISTRY
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 2454 WINGFIELD HILLS ROAD SUITE 100
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City | SPARKS
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State | NV
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Zip | 89436
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Country | US
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Telephone | 775-525-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN MCEVOY
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Credential |
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Telephone | 714-845-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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