Individual
DR. RYAN DAVID SPARKS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2635 NW ROLLING GREEN DR, CORVALLIS, OR 97330-3519
(541) 754-9322
(541) 754-4940
Mailing address
2635 NW ROLLING GREEN DR, CORVALLIS, OR 97330-3519
(541) 754-9322
(541) 754-4940
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7602
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1329915
UNITED CONCORDIA
—
Enumeration date
08/10/2005
Last updated
07/08/2007
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