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General NPI Number Information
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NPI Number | 1922752195
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Entity Type | Organization
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Legal Business Name | HAPPY 5 PLLC
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 1930 MAIN ST
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City | LONGMONT
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State | CO
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Zip | 80501-1984
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Country | US
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Telephone | 720-526-6936
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 MAIN ST
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City | LONGMONT
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State | CO
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Zip | 80501-1984
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Country | US
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Telephone | 720-526-6936
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DERREN TIPPETS
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Credential | DMD
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Telephone | 970-901-1889
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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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