Provider Demographics
NPI:1386470953
Name:PEARL & JADE PLLC
Entity type:Organization
Organization Name:PEARL & JADE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:720-899-6394
Mailing Address - Street 1:9568 W 56TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2108
Mailing Address - Country:US
Mailing Address - Phone:720-899-6394
Mailing Address - Fax:
Practice Address - Street 1:6979 S HOLLY CIR STE 260
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6253
Practice Address - Country:US
Practice Address - Phone:303-721-7214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty