Provider Demographics
NPI:1861857724
Name:A HAPPY SMILE DENTAL OFFICE, PC
Entity Type:Organization
Organization Name:A HAPPY SMILE DENTAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-493-9393
Mailing Address - Street 1:33054 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-8600
Mailing Address - Country:US
Mailing Address - Phone:315-493-9393
Mailing Address - Fax:315-493-9394
Practice Address - Street 1:33054 STATE ROUTE 26
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-8600
Practice Address - Country:US
Practice Address - Phone:315-493-9393
Practice Address - Fax:315-493-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-20
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty