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General NPI Number Information
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NPI Number | 1780132738
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Entity Type | Organization
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Legal Business Name | HAPPY BITES DENTAL GROUP LLC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 2910 N STATE ROAD 7
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1912
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Country | US
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Telephone | 786-261-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 N STATE ROAD 7
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1912
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Country | US
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Telephone | 786-261-1163
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LUIS CARLOS COLLAZOS
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Credential | DMD
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Telephone | 786-261-1163
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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 | 20855
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License Number State | FL
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