Provider Demographics
NPI:1902524044
Name:SPARKS MANAGEMENT GROUP PLLC
Entity Type:Organization
Organization Name:SPARKS MANAGEMENT GROUP PLLC
Other - Org Name:AQUA DENTAL WALLISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUDDASAR
Authorized Official - Middle Name:
Authorized Official - Last Name:TUKDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-436-2782
Mailing Address - Street 1:10223 BROADWAY ST STE D1
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7881
Mailing Address - Country:US
Mailing Address - Phone:713-436-2782
Mailing Address - Fax:713-588-8638
Practice Address - Street 1:5810 E SAM HOUSTON PKWY N STE L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2528
Practice Address - Country:US
Practice Address - Phone:713-436-2782
Practice Address - Fax:713-588-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty