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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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