Provider Demographics
NPI:1003107103
Name:SOUTHERN HIGHLANDS DENTAL, LLC
Entity Type:Organization
Organization Name:SOUTHERN HIGHLANDS DENTAL, LLC
Other - Org Name:ABSOLUTE DENTAL- SOUTHERN HIGHLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURBRINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-472-7290
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-435-5015
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:10660 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4114
Practice Address - Country:US
Practice Address - Phone:702-472-7290
Practice Address - Fax:702-366-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty