MEDICARE: HAPPY CAMPERS 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
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1578381646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY CAMPERS PEDIATRIC DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	8212 LOUISIANA BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2552
Country	:	US
Telephone Number	:	505-565-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	8212 LOUISIANA BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2552
Country	:	US
Telephone Number	:	505-565-5353
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUNG NOURI
Credential	:	DMD
Telephone Number	:	480-457-9383

Provider Enumeration Date	:	09/28/2024
Last Update Date	:	10/01/2024

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