Fresh Pediatric Dentistry PC
Dentist, Pediatric Dentistry in Montclair, NJ. Organization (NPI-2).
NPI number1497488985
StatusActive
Last updated in NPPESJun 2, 2023
Details
- NPI
- 1497488985
- Entity type
- Organization (NPI-2)
- Legal business name
- Fresh Pediatric Dentistry PC
- Organization subpart
- No
- Enumeration date
- Jul 2, 2022
- Certification date
- Jun 2, 2023
- Last updated
- Jun 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | – | – | Yes |
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | – | – |
Other names
- Sparkles Dentistry For Children (Doing Business As)
- Sparkles Pediatric Dentistry Of Montclair PC (Former Legal Business Name)
Practice location
39 South Fullerton AveSuite 10
Montclair, NJ 07042
Phone 347-979-2185
Mailing address
214 50th Ave#507e
Long Island City, NY 11101-5935
Phone 617-708-5108
Authorized official
Reesha Patel Shah
Owner
6177085108
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Other Pediatric Dentistry providers in Montclair, NJ
- Tyra Manso, DDSNPI 1467618512
- Natasha M Mathias, DMDNPI 1265606339
- Vrinda NanavatiNPI 1427559491
- Reesha Patel Shah, D.M.DNPI 1609154723
- William Clavis Warren, D.D.S.NPI 1578677571
All 6 Pediatric Dentistry providers in Montclair · All 1,965 providers in Montclair
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