Provider Demographics
NPI:1982010633
Name:PEARL SMILE PLLC
Entity Type:Organization
Organization Name:PEARL SMILE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-740-0646
Mailing Address - Street 1:8600 QUIOCCASIN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5514
Mailing Address - Country:US
Mailing Address - Phone:804-740-0646
Mailing Address - Fax:804-740-0646
Practice Address - Street 1:8600 QUIOCCASIN RD STE 205
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-5514
Practice Address - Country:US
Practice Address - Phone:804-740-0646
Practice Address - Fax:804-740-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty