Provider Demographics
NPI:1841371663
Name:HAPPY SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:HAPPY SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-323-7645
Mailing Address - Street 1:4781 E CAMP LOWELL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1290
Mailing Address - Country:US
Mailing Address - Phone:520-323-7645
Mailing Address - Fax:520-298-7376
Practice Address - Street 1:505 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6045
Practice Address - Country:US
Practice Address - Phone:520-323-7645
Practice Address - Fax:520-298-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76724Medicare UPIN
AZ76916Medicare ID - Type Unspecified