# SPARK ORAL SURGERY PA, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316728652
- **Authorized official:** PHI LE (GENERAL COUNSEL)
- **Authorized official phone:** (267) 575-2321

## Contact information

- **Practice address:** 330 LAUREL MALL, HAZLE TOWNSHIP, PA 18202-1205
- **Practice address phone:** (610) 223-7777
- **Mailing address:** 300 WILLOWBROOK LN STE 330, WEST CHESTER, PA 19382-5594

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2023
- **Last updated:** 08/15/2024