Organization · Type 2 NPI

Fresh Pediatric Dentistry PC

Pediatric Dentistry · Montclair, NJ

NPI number 1497488985 Active

Practice location

39 South Fullerton Ave, Suite 10
Montclair, NJ 07042

Call (347) 979-2185 Map

Mailing address

214 50th Ave, #507E
Long Island City, NY 11101-5935

Specialties and licenses

Taxonomy	Code	License
Pediatric Dentistry Primary	1223P0221X	None listed
Orthodontics and Dentofacial Orthopedics Dentistry	1223X0400X	None listed

Pediatric Dentistry: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

NPI record

NPI: 1497488985
Entity type: Organization (Type 2)
Issued: Jul 2, 2022
Last updated: Jun 2, 2023
Status: Active

Other names

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Sparkles Dentistry for Children · doing business as
Sparkles Pediatric Dentistry of Montclair PC · former legal business name

Authorized official

Dr. Reesha Patel Shah, DMD
Owner
(617) 708-5108

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1497488985

Fresh Pediatric Dentistry PC's National Provider Identifier is 1497488985, issued on Jul 2, 2022. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Montclair, NJ. The record was last updated on Jun 2, 2023.