Provider Demographics
NPI:1144977760
Name:SPARKLING PEARLS PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SPARKLING PEARLS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-292-0361
Mailing Address - Street 1:164 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3212
Mailing Address - Country:US
Mailing Address - Phone:917-292-0361
Mailing Address - Fax:
Practice Address - Street 1:164 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3212
Practice Address - Country:US
Practice Address - Phone:917-292-0361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty