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General NPI Number Information
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NPI Number | 1407673189
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Entity Type | Organization
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Legal Business Name | HAPPY SMILE WOONSOCKET LLC
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 175 HARRIS AVE
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City | WOONSOCKET
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State | RI
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Zip | 02895-1810
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Country | US
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Telephone | 401-723-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 885 SMITHFIELD AVE
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City | LINCOLN
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State | RI
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Zip | 02865-3508
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Country | US
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Telephone | 714-757-2525
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JONG HOON PARK
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Credential | DMD
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Telephone | 714-757-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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