| 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. |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 03/13/2012 |
| Last Update Date | 03/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114292984 | NPI | - | NPPES |
| 200343870A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6347 (Oklahoma) | Primary |