NPIMap

Organization Active NPI

Spark Dentistry PLLC

  • General Practice Dentistry
  • Prescott Valley, AZ
National Provider Identifier
1073234241
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SPARK DENTISTRY PLLC
Practice address
7584 E State Route 69
Prescott Valley, AZ 86314-2278
Phone
(928) 499-3061
NPI assigned
Sep 7, 2022
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Simon ParkNPI 1962051292
Title
Owner
Phone
(928) 499-3061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

7584 E State Route 69
Prescott Valley, AZ 86314-2278

Mailing address

PO Box 70887
Cleveland, OH 44190-0887

National Provider Directory

National Provider Directory

Locations

7584 E State Route 69
Prescott Valley, AZ 86314
Phone (510) 736-9890

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1073234241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70887",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441900887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7584 E STATE ROUTE 69",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142278",
            "telephone_number": "928-499-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-499-3061"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.