Healthcare Provider Details

I. General information

NPI: 1881504009
Provider Name (Legal Business Name): SPARK DENTAL OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E MAIN ST
WEST JEFFERSON OH
43162-1244
US

IV. Provider business mailing address

1801 W END AVE STE 530
NASHVILLE TN
37203-2515
US

V. Phone/Fax

Practice location:
  • Phone: 614-870-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHERRIE EDMONDSON
Title or Position: DIRECTOR
Credential:
Phone: 629-999-8612