Provider Demographics
NPI:1033579289
Name:PEARL COSMETIC DENTISTRY & AESTHETICS, INC
Entity Type:Organization
Organization Name:PEARL COSMETIC DENTISTRY & AESTHETICS, INC
Other - Org Name:PEARL CDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-698-0325
Mailing Address - Street 1:7215 SAWMILL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5001
Mailing Address - Country:US
Mailing Address - Phone:614-698-0325
Mailing Address - Fax:614-698-0327
Practice Address - Street 1:7215 SAWMILL RD STE 210
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5001
Practice Address - Country:US
Practice Address - Phone:614-698-0325
Practice Address - Fax:614-698-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty