# SPARKS FAMILY DENTISTRY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336264936
- **Authorized official:** DR. THOMAS AJ BASORA DDS (MANAGER)
- **Authorized official phone:** (775) 359-3337

## Contact information

- **Practice address:** 340 PYRAMID WAY, SPARKS, NV 89431
- **Practice address phone:** (775) 359-3336
- **Practice address fax:** (775) 359-0755
- **Mailing address:** 340 PYRAMID WAY, SPARKS, NV 89431
- **Mailing address phone:** (775) 359-3336
- **Mailing address fax:** (775) 359-0755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4481 | NV | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4481 | LIC \# | NV |