Provider Demographics
NPI:1831503358
Name:SPARKS, ERICA RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:RYAN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EMINENCE TER
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-1145
Mailing Address - Country:US
Mailing Address - Phone:502-845-5338
Mailing Address - Fax:
Practice Address - Street 1:105 EMINENCE TER
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019
Practice Address - Country:US
Practice Address - Phone:502-845-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist