Provider Demographics
NPI:1164245676
Name:SPARKS, WHITNEY LASHAE (RDH)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LASHAE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5041
Mailing Address - Country:US
Mailing Address - Phone:931-644-6605
Mailing Address - Fax:
Practice Address - Street 1:2815 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5041
Practice Address - Country:US
Practice Address - Phone:931-644-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009037124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist