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General NPI Number Information
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NPI Number | 1972900512
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Entity Type | Organization
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Legal Business Name | HAPPY SMILES, VCC, LLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 10101 BROOK RD SUITE 804A
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City | GLEN ALLEN
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State | VA
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Zip | 23059-4225
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Country | US
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Telephone | 804-266-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 10101 BROOK RD SUITE 804A
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City | GLEN ALLEN
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State | VA
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Zip | 23059-4225
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Country | US
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Telephone | 804-266-2400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH STONER
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Credential |
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Telephone | 804-266-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005143
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License Number State | VA
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