NPIMap

Organization Active NPI

Spark Dental VA, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bristol, VA
National Provider Identifier
1710647433
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
SPARK DENTAL VA, PLLC
Practice address
235 Linden SQ
Bristol, VA 24202-5875
Phone
(276) 642-0043
NPI assigned
Dec 21, 2021
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Carol Lynn Goings
Title
MGR
Phone
(615) 478-7166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

235 Linden SQ
Bristol, VA 24202-5875

Mailing address

1540 Rock Springs Rd
Smyrna, TN 37167-6141
Phone (615) 672-7221

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Bristol@TNBraces.com Direct

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: bristol@tnbraces.com

Practitioners & affiliated clinicians

Practitioners 1

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": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1710647433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 ROCK SPRINGS RD",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371676141",
            "telephone_number": "615-672-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 LINDEN SQ",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242025875",
            "telephone_number": "276-642-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK DENTAL VA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "GOINGS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "615-478-7166"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Bristol@TNBraces.com",
            "affiliation": "N",
            "endpointDescription": "Company email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "235 Linden Sq",
            "city": "Bristol",
            "state": "VA",
            "country_code": "US",
            "postal_code": "242025875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bristol, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.