Provider Demographics
NPI:1275418899
Name:SPARKLING SMILE CARE SERVICES
Entity type:Organization
Organization Name:SPARKLING SMILE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOKHANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-600-4330
Mailing Address - Street 1:3201 W PEORIA AVE STE A103A104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:623-600-4330
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE A103-104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:623-600-4330
Practice Address - Fax:602-609-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty