Provider Demographics
NPI:1972900512
Name:HAPPY SMILES, VCC, LLC
Entity type:Organization
Organization Name:HAPPY SMILES, VCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-266-2400
Mailing Address - Street 1:10101 BROOK RD
Mailing Address - Street 2:SUITE 804A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4225
Mailing Address - Country:US
Mailing Address - Phone:804-266-2400
Mailing Address - Fax:
Practice Address - Street 1:10101 BROOK RD
Practice Address - Street 2:SUITE 804A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4225
Practice Address - Country:US
Practice Address - Phone:804-266-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty