Beau Sparkman D.d.s., P.a. | |
104 W Ray Fine Blvd Suite 5 Roland OK 74954-5289 | |
(918) 503-6262 | |
Not Available |
Full Name | Beau Sparkman D.d.s., P.a. |
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Speciality | Dentist - General Practice |
Location | 104 W Ray Fine Blvd, Roland, Oklahoma |
Authorized Official Name and Position | Beau Sparkman (PRESIDENT) |
Authorized Official Contact | 4797394999 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Beau Sparkman D.d.s., P.a. 104 W Ray Fine Blvd Suite 5 Roland OK 74954-5289 Ph: (918) 503-6262 | Beau Sparkman D.d.s., P.a. 104 W Ray Fine Blvd Suite 5 Roland OK 74954-5289 Ph: (918) 503-6262 |
NPI Number | 1114292984 |
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Provider Enumeration Date | 03/13/2012 |
Last Update Date | 03/13/2012 |
Identifier | Type | State | Issuer |
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1114292984 | NPI | - | NPPES |
200343870A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 6347 (Oklahoma) | Primary |