MEDICARE: HAPPY BITES DENTAL GROUP 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	122300000X	Dentist	20855	FL

General Provider Information

NPI Number	:	1780132738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY BITES DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	2910 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1912
Country	:	US
Telephone Number	:	786-261-1163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1912
Country	:	US
Telephone Number	:	786-261-1163
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LUIS CARLOS COLLAZOS
Credential	:	DMD
Telephone Number	:	786-261-1163

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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