Beau E Sparkman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6347 Issued in OK

Practice address

104 W Ray Fine Blvd
Ste. 5
Roland, OK 74954-5289

Phone

(918) 503-6262

Fax

(918) 913-4595

NPI assigned

Jun 28, 2011

Last updated

Feb 3, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beau Sparkman D.D.S., P.a.

  • General Practice Dentistry
  • Roland, OK
  • NPI 1114292984
  NPD Authorized official
• Beau Sparkman D.D.S., P.a.

  dba Family Dental Care of Ft. Smith

  • Dental Clinic/Center
  • Fort Smith, AR
  • NPI 1710442728
  NPD Authorized official
• Riley Farm Dental & Braces, PLLC

  • Dental Clinic/Center
  • Fort Smith, AR
  • NPI 1598324220
  NPD

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1437445400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W RAY FINE BLVD",
            "address_2": "STE. 5",
            "city": "ROLAND",
            "state": "OK",
            "postal_code": "749545289",
            "telephone_number": "918-503-6262",
            "fax_number": "918-913-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W RAY FINE BLVD",
            "address_2": "STE. 5",
            "city": "ROLAND",
            "state": "OK",
            "postal_code": "749545289",
            "telephone_number": "918-503-6262",
            "fax_number": "918-913-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKMAN",
        "first_name": "BEAU",
        "middle_name": "E",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-28",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3833",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Roland, OK
• Providers in Roland, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.