FRESH PEDIATRIC DENTISTRY PC NPI 1497488985

NPI Information

  • NPI: 1497488985
  • Provider Name: FRESH PEDIATRIC DENTISTRY PC
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Organization
  • Doing Business As: SPARKLES DENTISTRY FOR CHILDREN
  • Address: 39 SOUTH FULLERTON AVE
    SUITE 10
    MONTCLAIR, NJ
    ZIP 07042
  • Phone: (347) 979-2185

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NPI Details

FRESH PEDIATRIC DENTISTRY PC is a pediatric dentistry dentist in Montclair, NJ. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. FRESH PEDIATRIC DENTISTRY PC NPI is 1497488985. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Sparkles Dentistry For Children.

The provider's business location address is:

39 SOUTH FULLERTON AVE
SUITE 10
MONTCLAIR, NJ
ZIP 07042
Phone: (347) 979-2185

The provider's authorized official is Reesha Patel Shah .
The authorized official title is Owner and has the following contact phone number (617) 708-5108.

The enumeration date for this NPI number is 7/2/2022 and was last updated on 6/2/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223X0400XDentistOrthodontics and Dentofacial OrthopedicsNo
21223P0221XDentistPediatric DentistryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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