Provider Demographics
NPI:1386488690
Name:SPARLIN, IVY S (DDS)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:S
Last Name:SPARLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1310
Mailing Address - Country:US
Mailing Address - Phone:620-446-2267
Mailing Address - Fax:
Practice Address - Street 1:1216 E HARTFORD AVE STE 1A
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2059
Practice Address - Country:US
Practice Address - Phone:580-762-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice