Provider Demographics
NPI:1629840830
Name:SPARQ DENTAL PERTH AMBOY INC
Entity Type:Organization
Organization Name:SPARQ DENTAL PERTH AMBOY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-851-9419
Mailing Address - Street 1:288 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4348
Mailing Address - Country:US
Mailing Address - Phone:732-442-6100
Mailing Address - Fax:
Practice Address - Street 1:288 STATE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4348
Practice Address - Country:US
Practice Address - Phone:732-442-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental