Provider Demographics
NPI:1396255501
Name:HAPPY FAMILY DENTAL GROUP, INC.
Entity type:Organization
Organization Name:HAPPY FAMILY DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-449-1110
Mailing Address - Street 1:510 WESTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-651-0165
Mailing Address - Fax:813-651-0174
Practice Address - Street 1:510 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-651-0165
Practice Address - Fax:813-651-0174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAPPY FAMILY DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH17860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty