Provider Demographics
NPI:1124482427
Name:HAPPY VALLEY SMILES
Entity type:Organization
Organization Name:HAPPY VALLEY SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-566-0150
Mailing Address - Street 1:6615 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2608
Mailing Address - Country:US
Mailing Address - Phone:623-566-0150
Mailing Address - Fax:623-566-4075
Practice Address - Street 1:6615 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2608
Practice Address - Country:US
Practice Address - Phone:623-566-0150
Practice Address - Fax:623-566-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty