MEDICARE: HAPPY VALLEY MODERN DENTISTRY, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1740921527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY VALLEY MODERN DENTISTRY, PC

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	13180 SE 172ND AVE STE 146
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-9654
Country	:	US
Telephone Number	:	503-353-6568
Fax Number	:	503-212-4756

Authorized Official
Title or Position	:	OWNER
Name	:	SUMEET PANDHOH
Credential	:	DDS
Telephone Number	:	503-353-6568

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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