Provider Demographics
NPI:1609475060
Name:HAPPY MOLAR DENTAL LLC
Entity Type:Organization
Organization Name:HAPPY MOLAR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-900-7838
Mailing Address - Street 1:3695 E LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7820
Mailing Address - Country:US
Mailing Address - Phone:773-988-5889
Mailing Address - Fax:
Practice Address - Street 1:67 N DOBSON RD STE A-104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6822
Practice Address - Country:US
Practice Address - Phone:480-900-7838
Practice Address - Fax:480-999-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty