Organization
SPARK DENTAL IN, LLC
Active
Other names
Werner Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
PHI LE (CREDENTIALING MANAER)
(267) 575-2321
Entity
Organization
Contact information
Practice address
9602 E WASHINGTON ST STE B, INDIANAPOLIS, IN 46229-3060
(317) 898-7645
Mailing address
300 WILLOWBROOK LN STE 330, WEST CHESTER, PA 19382-5594
(267) 575-2321
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/17/2022
Last updated
11/17/2022
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