Sparkle Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901020415 Issued in MI

Legal business name

SPARKLE DENTAL LLC

Practice address

30801 Schoenherr Rd
Ste 200
Warren, MI 48088-6857

Phone

(586) 751-2020

Fax

(586) 751-7872

NPI assigned

Mar 21, 2012

Last updated

Mar 21, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Monica Malak Assad, DDS

Title

Dentist

Phone

(586) 751-2020

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1306111521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30801 SCHOENHERR RD",
            "address_2": "STE 200",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480886857",
            "telephone_number": "586-751-2020",
            "fax_number": "586-751-7872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30801 SCHOENHERR RD",
            "address_2": "STE 200",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480886857",
            "telephone_number": "586-751-2020",
            "fax_number": "586-751-7872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKLE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "ASSAD",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "MALAK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "586-751-2020",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Warren, MI
• Providers in Warren, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.