Basic Information
| Provider Information | |||||||||
| NPI: | 1194071456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPARROW | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19111 SE 34TH ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986831449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608230427 | ||||||||
| FaxNumber: | 3608230428 | ||||||||
| Practice Location | |||||||||
| Address1: | 19111 SE 34TH ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986831449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608230427 | ||||||||
| FaxNumber: | 3608230428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60300516 | WA | Y | Dental Providers | Dentist |
No ID Information.