Provider Demographics
NPI:1376176198
Name:HAPPY TOOTH PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:HAPPY TOOTH PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:801-946-2565
Mailing Address - Street 1:1850 ORANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5725
Mailing Address - Country:US
Mailing Address - Phone:801-946-2565
Mailing Address - Fax:
Practice Address - Street 1:2453 E 3300 S
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84109-2725
Practice Address - Country:US
Practice Address - Phone:801-946-2565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty