Provider Demographics
NPI:1336883131
Name:SPARKLE DENTAL PC
Entity type:Organization
Organization Name:SPARKLE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMULAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-857-6225
Mailing Address - Street 1:15295 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-8706
Mailing Address - Country:US
Mailing Address - Phone:610-685-6955
Mailing Address - Fax:610-685-6955
Practice Address - Street 1:15295 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-8706
Practice Address - Country:US
Practice Address - Phone:610-685-6955
Practice Address - Fax:610-685-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty