Provider Demographics
NPI:1609491406
Name:THE HAPPY TOOTH, LLC
Entity Type:Organization
Organization Name:THE HAPPY TOOTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-756-8960
Mailing Address - Street 1:8288 KENAI SPUR HWY
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8901
Mailing Address - Country:US
Mailing Address - Phone:907-756-8960
Mailing Address - Fax:
Practice Address - Street 1:625 ELM ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-1728
Practice Address - Country:US
Practice Address - Phone:765-832-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty