Provider Demographics
NPI:1336592252
Name:HAPPY TOOTH
Entity Type:Organization
Organization Name:HAPPY TOOTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIN
Authorized Official - Middle Name:ASMER
Authorized Official - Last Name:AWANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDSPC
Authorized Official - Phone:248-219-5863
Mailing Address - Street 1:31207 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3761
Mailing Address - Country:US
Mailing Address - Phone:586-553-9399
Mailing Address - Fax:
Practice Address - Street 1:31207 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3761
Practice Address - Country:US
Practice Address - Phone:586-553-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty