MEDICARE: HAPPY SMILES DENTAL GROUP, INC

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
1	122300000X	Dentist	DN11505	FL

General Provider Information

NPI Number	:	1518176361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY SMILES DENTAL GROUP, INC

Provider Business Mailing Address
First Line	:	4901 NW 4TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5105
Country	:	US
Telephone Number	:	305-446-8115
Fax Number	:	305-446-5023

Provider Business Practice Location Address
First Line	:	4901 NW 4TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5105
Country	:	US
Telephone Number	:	305-446-8115
Fax Number	:	305-446-5023

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS MARLYN RODRIGUEZ
Credential	:
Telephone Number	:	305-446-8115

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/29/2008

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