Organization
SPARK ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHI LE (CREDENTIALING MANAGER)
(267) 575-2321
Entity
Organization
Contact information
Practice address
2301 E ALLEGHENY AVE STE 300M, PHILADELPHIA, PA 19134-4427
(833) 543-7678
Mailing address
300 WILLOWBROOK LN STE 330, WEST CHESTER, PA 19382-5594
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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