Provider Demographics
NPI:1700553815
Name:HAPPY TEETH DENTAL INC
Entity Type:Organization
Organization Name:HAPPY TEETH DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:IMELDA
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-443-7494
Mailing Address - Street 1:469 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2311
Mailing Address - Country:US
Mailing Address - Phone:559-443-7494
Mailing Address - Fax:
Practice Address - Street 1:469 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2311
Practice Address - Country:US
Practice Address - Phone:559-443-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental