Provider Demographics
NPI:1093442444
Name:PEARL PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:PEARL PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-278-1215
Mailing Address - Street 1:1014A GALE LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2914
Mailing Address - Country:US
Mailing Address - Phone:727-278-1215
Mailing Address - Fax:
Practice Address - Street 1:820 NORTH MT. JULIET ROAD SUITE100
Practice Address - Street 2:
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-667-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty