Provider Demographics
NPI:1891973327
Name:HAPPY VALLEY PEDIATRIC DENTISTRY, PLC
Entity Type:Organization
Organization Name:HAPPY VALLEY PEDIATRIC DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-516-2800
Mailing Address - Street 1:2020 W WHISPERING WIND DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2848
Mailing Address - Country:US
Mailing Address - Phone:623-516-2800
Mailing Address - Fax:623-516-2806
Practice Address - Street 1:2020 W WHISPERING WIND DR
Practice Address - Street 2:SUITE 113
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2848
Practice Address - Country:US
Practice Address - Phone:623-516-2800
Practice Address - Fax:623-516-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty