Organization
SPARK DENTAL VA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL LYNN GOINGS (MGR)
(615) 478-7166
Entity
Organization
Contact information
Practice address
235 LINDEN SQ, BRISTOL, VA 24202-5875
(276) 642-0043
Mailing address
1540 ROCK SPRINGS RD, SMYRNA, TN 37167-6141
(615) 672-7221
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/21/2021
Last updated
12/21/2021
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