Provider Demographics
NPI:1225428824
Name:BLUE PEARL DENTISTRY
Entity type:Organization
Organization Name:BLUE PEARL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-288-4175
Mailing Address - Street 1:1080 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2591
Mailing Address - Country:US
Mailing Address - Phone:424-288-4175
Mailing Address - Fax:
Practice Address - Street 1:1080 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2591
Practice Address - Country:US
Practice Address - Phone:424-288-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56353261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental