Provider Demographics
NPI:1114137775
Name:IAN VAN ZYL BDS,DDS,MS & EWA KONOPKA,DDS,APC
Entity Type:Organization
Organization Name:IAN VAN ZYL BDS,DDS,MS & EWA KONOPKA,DDS,APC
Other - Org Name:HAPPY SMILES DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-987-2773
Mailing Address - Street 1:21038 CALISTOGA ST.
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-1124
Mailing Address - Country:US
Mailing Address - Phone:707-987-2773
Mailing Address - Fax:707-987-0688
Practice Address - Street 1:21038 CALISTOGA ST.
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95461-1124
Practice Address - Country:US
Practice Address - Phone:707-987-2773
Practice Address - Fax:707-987-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty