Organization
FRESH PEDIATRIC DENTISTRY PC
Active
Other names
Sparkles Dentistry for Children, Sparkles Pediatric Dentistry of Montclair PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REESHA PATEL SHAH DMD (OWNER)
(617) 708-5108
Entity
Organization
Contact information
Practice address
39 SOUTH FULLERTON AVE, SUITE 10, MONTCLAIR, NJ 07042
(347) 979-2185
Mailing address
214 50TH AVE, #507E, LONG ISLAND CITY, NY 11101-5935
(617) 708-5108
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
07/02/2022
Last updated
06/02/2023
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