Organization
BEAU SPARKMAN D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU SPARKMAN D.D.S. (PRESIDENT)
(479) 739-4999
Entity
Organization
Contact information
Practice address
104 W RAY FINE BLVD, SUITE 5, ROLAND, OK 74954-5289
(918) 503-6262
Mailing address
104 W RAY FINE BLVD, SUITE 5, ROLAND, OK 74954-5289
(918) 503-6262
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6347
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200343870A
—
OK
Enumeration date
03/13/2012
Last updated
03/13/2012
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