# SPARKLE KIDS DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548544471
- **Authorized official:** PREETI GUPTA DDS (PEDIATRIC DENTIST)
- **Authorized official phone:** (201) 475-1600

## Contact information

- **Practice address:** 15-01 BROADWAY STE 18, FAIR LAWN, NJ 07410-6018
- **Practice address phone:** (201) 475-1600
- **Mailing address:** 15-01 BROADWAY STE 18, FAIR LAWN, NJ 07410-6018

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI02285400 | NJ | — |
| 122300000X | Dentist | 22DI02290400 | NJ | Yes |
| 1223P0221X | Pediatric Dentistry | 22DI02290400 | NJ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02285400 | NJ | — |

## Other

- **Enumeration date:** 10/11/2011
- **Last updated:** 10/11/2011