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General NPI Number Information
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NPI Number | 1851776553
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Entity Type | Organization
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Legal Business Name | SPARK ORTHODONTICS
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 5021 ROUTE 873
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City | SCHNECKSVILLE
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State | PA
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Zip | 18078-2213
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Country | US
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Telephone | 610-865-2777
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Fax | 610-865-1099
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Provider Business Mailing Address
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Address Line | 5021 ROUTE 873
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City | SCHNECKSVILLE
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State | PA
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Zip | 18078-2213
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Country | US
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Telephone | 610-865-2777
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Fax | 610-865-1099
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. JASON M HARTMAN
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Credential | D.M.D., M.S
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Telephone | 610-865-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS038055
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License Number State | PA
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