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NPI Code Detail

MEDICARE: HAPPY TOOTH PEDIATRIC DENTISTRY, LLC

MEDICARE: HAPPY TOOTH PEDIATRIC DENTISTRY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1376176198
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAPPY TOOTH PEDIATRIC DENTISTRY, LLC
Provider Business Mailing Address
First Line : 1850 ORANGEWOOD DR
Second Line :
City : MEDFORD
State : OR
Zip : 97504-5725
Country : US
Telephone Number : 801-946-2565
Fax Number :
Provider Business Practice Location Address
First Line : 2453 E 3300 S
Second Line :
City : MILLCREEK
State : UT
Zip : 84109-2725
Country : US
Telephone Number : 801-946-2565
Fax Number :
Authorized Official
Title or Position : SOLE OWNER
Name : DR. TYLER DALE HANKS
Credential : DMD, MPH
Telephone Number : 801-946-2565
Provider Enumeration Date : 02/20/2020
Last Update Date : 02/20/2020

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Directions to “HAPPY TOOTH PEDIATRIC DENTISTRY, LLC ” Practice Location

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