Spark Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SPARK DENTAL LLC

Practice address

18077 Garland Groh Blvd
Hagerstown, MD 21740-2064

Phone

(301) 888-8555

NPI assigned

May 22, 2024

Last updated

May 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Madhu Venkata Rama Raju Nadimpalli, DDS,MPANPI 1003126137

Title

General Dentist/ Owner

Phone

(201) 257-7095

Specialties & licenses 1

Addresses

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.

• Madhu Venkata Rama Raju Nadimpalli, DDS

  • Dentist
  • District Heights, MD
  • NPI 1003126137
  Authorized official Same address or phone

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

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1760221386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12233 HAYLAND FARM WAY",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210426027",
            "telephone_number": "201-257-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18077 GARLAND GROH BLVD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217402064",
            "telephone_number": "301-888-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "NADIMPALLI",
        "authorized_official_first_name": "MADHU  VENKATA",
        "authorized_official_middle_name": "RAMA RAJU",
        "authorized_official_title_or_position": "GENERAL DENTIST/ OWNER",
        "authorized_official_telephone_number": "201-257-7095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MPA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.