Provider Demographics
NPI:1154980787
Name:PEARL DENTAL
Entity type:Organization
Organization Name:PEARL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WISDOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:AKPAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-305-6246
Mailing Address - Street 1:1401 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6746
Mailing Address - Country:US
Mailing Address - Phone:561-305-6246
Mailing Address - Fax:
Practice Address - Street 1:1401 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6746
Practice Address - Country:US
Practice Address - Phone:561-305-6246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty