MEDICARE: WHITNEY LASHAE SPARKS RDH

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	124Q00000X	Dental Hygienist	0000009037	TN

General Provider Information

NPI Number	:	1164245676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY LASHAE SPARKS RDH

Provider Business Mailing Address
First Line	:	2815 OAK PARK DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5041
Country	:	US
Telephone Number	:	931-644-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 OAK PARK DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-5041
Country	:	US
Telephone Number	:	931-644-6605
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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Directions to “ WHITNEY LASHAE SPARKS RDH” Practice Location

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