1447701081 NPI number — MHB2-PLLC

Table of content: (NPI 1447701081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447701081 NPI number — MHB2-PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MHB2-PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAPPY TEETH DENTAL CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447701081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3805 SPRINGBRANCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENBROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76116-7631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-702-8678
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4731 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76103-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-531-0431
Provider Business Practice Location Address Fax Number:
817-531-2389
Provider Enumeration Date:
10/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TEHRANI
Authorized Official First Name:
SALOMEH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-702-8678

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  26254 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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