Provider Demographics
NPI:1689404824
Name:SPARKLE DENTAL GROUP LLC
Entity type:Organization
Organization Name:SPARKLE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-968-8439
Mailing Address - Street 1:4121 FAIRVIEW AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2267
Mailing Address - Country:US
Mailing Address - Phone:630-968-8439
Mailing Address - Fax:630-968-7259
Practice Address - Street 1:4121 FAIRVIEW AVE STE 205
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2267
Practice Address - Country:US
Practice Address - Phone:630-968-8439
Practice Address - Fax:630-968-7259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARKLE DENTAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty