Provider Demographics
NPI:1699093799
Name:PEARLS DENTAL LLC
Entity type:Organization
Organization Name:PEARLS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTTUVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS BDS
Authorized Official - Phone:609-509-4090
Mailing Address - Street 1:1 UNION ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-4219
Mailing Address - Country:US
Mailing Address - Phone:609-509-4090
Mailing Address - Fax:866-792-8513
Practice Address - Street 1:1 UNION ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-4219
Practice Address - Country:US
Practice Address - Phone:609-509-4090
Practice Address - Fax:866-792-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0186881Medicaid