Spark Oral Surgery PA, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SPARK ORAL SURGERY PA, PLLC

Practice address

330 Laurel Mall
Hazle Township, PA 18202-1205

Phone

(610) 223-7777

NPI assigned

Oct 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phi Le

Title

General Counsel

Phone

(267) 575-2321

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1316728652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WILLOWBROOK LN STE 330",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193825594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LAUREL MALL",
            "city": "HAZLE TOWNSHIP",
            "state": "PA",
            "postal_code": "182021205",
            "telephone_number": "610-223-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK ORAL SURGERY PA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-12",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "PHI",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "267-575-2321"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Sherman, CRNP-BC
• Hilary Shershen
• Annie D.K. Singh, MSN, CRNP
• Keely Slifer
• Alvin Soto-Soto, MD
• Spero Physicians of Pennsylvania, PC
• Peter John Spohn, MD
• St. Luke'S Physician Group, Inc
• Laura Amann Storm, PA-C
• Angela Sullivan, M.S., OTR/L

• Oral and Maxillofacial Surgery (Dentist) in Hazle Township, PA
• Providers in Hazle Township, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.