Provider Demographics
NPI:1578942413
Name:SPARKLE SMILES PLLC
Entity Type:Organization
Organization Name:SPARKLE SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILUVOJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-423-4336
Mailing Address - Street 1:1921 N MAIN CENTER
Mailing Address - Street 2:115
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1921 N MAIN CENTER
Practice Address - Street 2:115
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3364
Practice Address - Country:US
Practice Address - Phone:732-423-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty