NPIMap

Organization Active NPI

Fresh Pediatric Dentistry PC

  • Pediatric Dentistry
  • Montclair, NJ
National Provider Identifier
1497488985
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
FRESH PEDIATRIC DENTISTRY PC
Practice address
39 South Fullerton Ave
Suite 10
Montclair, NJ 07042
Phone
(347) 979-2185
NPI assigned
Jul 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Authorized official

Name
Dr. Reesha Patel Shah, DMDNPI 1609154723
Title
Owner
Phone
(617) 708-5108

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

39 South Fullerton Ave
Suite 10
Montclair, NJ 07042

Mailing address

214 50TH Ave
#507E
Long Island City, NY 11101-5935
Phone (617) 708-5108

Other names 2

  • Sparkles Dentistry for Children Doing business as
  • Sparkles Pediatric Dentistry of Montclair PC Former legal business name

National Provider Directory

National Provider Directory

Locations

39 S Fullerton Ave
Ste 10
Montclair, NJ 07042
Phone (973) 233-5144

76 Bellevue Ave
Upper Montclair, NJ 07043
Phone (973) 744-3127

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1656720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1497488985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 50TH AVE",
            "address_2": "#507E",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111015935",
            "telephone_number": "617-708-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 SOUTH FULLERTON AVE",
            "address_2": "SUITE 10",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "07042",
            "telephone_number": "347-979-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-02",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "REESHA",
        "authorized_official_middle_name": "PATEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-708-5108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sparkles Dentistry for Children",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sparkles Pediatric Dentistry of Montclair PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.