Individual
JORDAN SAMUEL SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3265 MARIETTA ST SE, SALEM, OR 97317-9402
(503) 910-0557
Mailing address
3265 MARIETTA ST SE, SALEM, OR 97317-9402
(503) 910-0557
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7601
OR
Other
Enumeration date
02/22/2007
Last updated
05/24/2023
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