Provider Demographics
NPI:1568107589
Name:PEARL DENTAL PLLC
Entity Type:Organization
Organization Name:PEARL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDOUTOUME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-273-8008
Mailing Address - Street 1:702 W MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650
Mailing Address - Country:US
Mailing Address - Phone:903-273-8008
Mailing Address - Fax:903-213-7440
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650
Practice Address - Country:US
Practice Address - Phone:903-273-8008
Practice Address - Fax:903-213-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32576OtherTEXAS STATE BOARD OF DENTAL EXAMINERS