Provider Demographics
NPI:1588154330
Name:LITTLE PEARLS DENTISTRY FOR CHILDREN, PC
Entity type:Organization
Organization Name:LITTLE PEARLS DENTISTRY FOR CHILDREN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAZORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-726-3030
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-726-3030
Mailing Address - Fax:703-726-5221
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-726-3030
Practice Address - Fax:703-726-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty