Provider Demographics
NPI:1578381646
Name:HAPPY CAMPERS PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:HAPPY CAMPERS PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-457-9383
Mailing Address - Street 1:8212 LOUISIANA BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2552
Mailing Address - Country:US
Mailing Address - Phone:505-565-5353
Mailing Address - Fax:
Practice Address - Street 1:8212 LOUISIANA BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2552
Practice Address - Country:US
Practice Address - Phone:505-565-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-28
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty