Sparkle Smiles PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28728 Issued in TX

Legal business name

SPARKLE SMILES PLLC

Practice address

110 Church St
Marlin, TX 76661

Phone

(732) 423-4336

NPI assigned

Sep 2, 2016

Organization subpart

No

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

Authorized official

Name

Pavan Chiluvoju

Title

Owner Dentist

Phone

(732) 423-4336

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1472774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1508313909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CHURCH ST",
            "city": "MARLIN",
            "state": "TX",
            "postal_code": "76661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CHURCH ST",
            "city": "MARLIN",
            "state": "TX",
            "postal_code": "76661",
            "telephone_number": "732-423-4336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKLE SMILES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-02",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "CHILUVOJU",
        "authorized_official_first_name": "PAVAN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "732-423-4336"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Marlin, TX
• Providers in Marlin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.