MEDICARE: HAPPY TEETH PHOENIX

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	:	1811377112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY TEETH PHOENIX

Provider Business Mailing Address
First Line	:	PO BOX 39920
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85069-0920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1850
Country	:	US
Telephone Number	:	602-841-4400
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARIA ROSA GONZALEZ ALANIS
Credential	:
Telephone Number	:	602-841-4400

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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Directions to “HAPPY TEETH PHOENIX ” Practice Location

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