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General NPI Number Information
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NPI Number | 1922632314
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Entity Type | Organization
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Legal Business Name | HAPPY TEETH NY LLC
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 220 RIVERSIDE BLVD
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City | NEW YORK
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State | NY
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Zip | 10069-1001
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Country | US
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Telephone | 212-810-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 50 RIVERSIDE BLVD APT 16D
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City | NEW YORK
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State | NY
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Zip | 10069-0248
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Country | US
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Telephone | 646-303-1394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANTANU LAL
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Credential | DDS
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Telephone | 646-303-1394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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