Organization
HAPPY TEETH NY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANTANU LAL DDS (OWNER)
(646) 303-1394
Entity
Organization
Contact information
Practice address
220 RIVERSIDE BLVD, NEW YORK, NY 10069-1001
(212) 810-6562
Mailing address
50 RIVERSIDE BLVD APT 16D, NEW YORK, NY 10069-0248
(646) 303-1394
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053628-1
DENTAL LICENSE
NY
01
—
1932365905
INDIVIDUAL NPI
—
Enumeration date
02/25/2020
Last updated
02/25/2020
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