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General NPI Number Information
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NPI Number | 1396255501
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Entity Type | Organization
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Legal Business Name | HAPPY FAMILY DENTAL GROUP, INC.
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 510 WESTBROOK AVE
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-651-0165
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Fax | 813-651-0174
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Provider Business Mailing Address
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Address Line | 510 WESTBROOK AVE
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-651-0165
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Fax | 813-651-0174
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRUZ M. CEINO
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Credential | D.M.D.
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Telephone | 813-449-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DH17860
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License Number State | FL
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