Organization Name: | SPARK ORTHODONTICS |
NPI Number: | 1851776553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON M HARTMAN (DOCTOR/OWNER) |
Mailing Address: | 5021 Route 873 Schnecksville |
State: | PA US |
Postal Code: | 180782213 |
Phone Number: | 6108652777 |
Fax Number: | 6108651099 |
NPI Enumeration Date: | 07/23/2015 |
NPI Last Update Date: | 07/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DS038055 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |