Organization
SPARK ORTHODONTICS
Active
Parent organization
SPARK ORTHODONTICS
Other names
Petras Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARK ORTHODONTICS
Authorized official
VAN PHI LE (CREDENTIALING MANAGER)
(267) 575-2321
Entity
Organization
Contact information
Practice address
2951 SAINT LAWRENCE AVE, READING, PA 19606-2256
(610) 779-6990
Mailing address
300 WILLOWBROOK LN STE 300, WEST CHESTER, PA 19382-5594
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
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