Provider Demographics
NPI:1740921527
Name:HAPPY VALLEY MODERN DENTISTRY, PC
Entity type:Organization
Organization Name:HAPPY VALLEY MODERN DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDHOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-353-6568
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:303-952-0892
Practice Address - Street 1:13180 SE 172ND AVE STE 146
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-9654
Practice Address - Country:US
Practice Address - Phone:503-353-6568
Practice Address - Fax:503-212-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty