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General NPI Number Information
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NPI Number | 1942113808
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Entity Type | Organization
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Legal Business Name | SPARK ORTHODONTICS SC LLC
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 415 FARRS BRIDGE RD
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City | GREENVILLE
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State | SC
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Zip | 29617-1858
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Country | US
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Telephone | 864-232-3333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 831228
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City | PHILADELPHIA
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State | PA
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Zip | 19182-1228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 629-666-8621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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