Organization
SPARKLE KIDS DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREETI GUPTA DDS (PEDIATRIC DENTIST)
(201) 475-1600
Entity
Organization
Contact information
Practice address
15-01 BROADWAY STE 18, FAIR LAWN, NJ 07410-6018
(201) 475-1600
Mailing address
15-01 BROADWAY STE 18, FAIR LAWN, NJ 07410-6018
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02285400
NJ
122300000X
Dentist
Primary
22DI02290400
NJ
1223P0221X
Pediatric Dentistry
22DI02290400
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI02285400
NJ
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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