Organization
SPARK ORAL SURGERY PA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHI LE (GENERAL COUNSEL)
(267) 575-2321
Entity
Organization
Contact information
Practice address
330 LAUREL MALL, HAZLE TOWNSHIP, PA 18202-1205
(610) 223-7777
Mailing address
300 WILLOWBROOK LN STE 330, WEST CHESTER, PA 19382-5594
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/12/2023
Last updated
08/15/2024
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