1518176361 NPI number — HAPPY SMILES DENTAL GROUP, INC

Table of content: (NPI 1518176361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518176361 NPI number — HAPPY SMILES DENTAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAPPY SMILES DENTAL GROUP, INC
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:
Provider Other Organization Name Type Code:
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:
1518176361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4901 NW 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-5105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-446-8115
Provider Business Mailing Address Fax Number:
305-446-5023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 NW 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-446-8115
Provider Business Practice Location Address Fax Number:
305-446-5023
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
MARLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
305-446-8115

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN11505 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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