=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801542790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAPPY OHANA SMILES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2022
-----------------------------------------------------
Last Update Date | 11/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5210 THOUSAND OAKS DR STE 1249
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-6974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-399-0825
-----------------------------------------------------
Fax | 210-610-5251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 SUGAR WOOD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78248-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-885-7634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATIONS OFFICER
-----------------------------------------------------
Name | DAVID OMAR ZAMORA
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 210-885-7634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 125Q00000X
-----------------------------------------------------
Taxonomy Name | Oral Medicine Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------