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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