Provider Demographics
NPI:1730937301
Name:SPARK PROSTHODONTICS AND IMPLANTS PLLC
Entity type:Organization
Organization Name:SPARK PROSTHODONTICS AND IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNAPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIPURAPU
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS, MS
Authorized Official - Phone:810-394-6268
Mailing Address - Street 1:4260 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2977
Mailing Address - Country:US
Mailing Address - Phone:810-394-6268
Mailing Address - Fax:
Practice Address - Street 1:4260 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2977
Practice Address - Country:US
Practice Address - Phone:810-394-6268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental