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Organization
SPARK DENTAL SC LLC
Active
Organization
SPARK DENTAL SC LLC
Active
Other names
Oak Tree Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRIE EDMONDSON (DIRECTOR OF CREDENTIALING)
(629) 666-8612
Entity
Organization
Contact information
Practice address
415 FARRS BRIDGE RD, GREENVILLE, SC 29617-1858
(864) 232-6800
Mailing address
PO BOX 831175, PHILADELPHIA, PA 19182-1175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/29/2026
Last updated
07/29/2026
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