Sparkle Dental Group LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SPARKLE DENTAL GROUP LLC

Doing business as

Dentique - Downers Grove

Practice address

4121 Fairview Ave Ste 205
Downers Grove, IL 60515-2267

Phone

(630) 968-8439

Fax

(630) 968-7259

NPI assigned

Aug 2, 2024

Organization subpart

Yes

Parent organization

SPARKLE DENTAL GROUP LLCAs reported in NPPES

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

Authorized official

Name

Pradeep Khurana

Title

Owner

Phone

(630) 968-8439

Specialties & licenses 1

Addresses

Other names 1

• Dentique - Downers Grove Doing business as

Tax ID family

Sparkle Dental Group LLC2 organizations share this tax ID, including this one

Part of

Sparkle Dental Group LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sparkle Dental Group LLC

  dba Dentique - Lemont

  • Dentist
  • Lemont, IL
  • NPI 1932939170
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mazar Shuaipaj, DDS

  • Dentist
  • Downers Grove, IL
  • NPI 1205993193
  NPD (past)

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1689404824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 FAIRVIEW AVE STE 205",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152267",
            "telephone_number": "630-968-8439",
            "fax_number": "630-968-7259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 FAIRVIEW AVE STE 205",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152267",
            "telephone_number": "630-968-8439",
            "fax_number": "630-968-7259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKLE DENTAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARKLE DENTAL GROUP LLC",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "KHURANA",
        "authorized_official_first_name": "PRADEEP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-968-8439"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentique - Downers Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• George R Sosenko, MD
• Dennis Joseph Sowa, R.PH.
• Elizabeth Sowa, MSN, ANP-BC
• Barbara Ryan Spall
• Jill O. Sparacio, OTR/L, ATP
• Victor Frank Spatafora, DOCTOR OF PSYCHOLOGY
• Jamie Specht
• Spectrum Diagnostic Imaging Inc
• Speech and Swallow Center PLLC
• Alexandra Speer, PA-C

• Dentist in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; 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.