Provider Demographics
NPI:1013232255
Name:HIGHLAND DENTAL CENTER RENTON
Entity Type:Organization
Organization Name:HIGHLAND DENTAL CENTER RENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REKHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-226-1422
Mailing Address - Street 1:1080 KIRKLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3415
Mailing Address - Country:US
Mailing Address - Phone:425-226-1422
Mailing Address - Fax:425-226-1423
Practice Address - Street 1:1080 KIRKLAND AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3415
Practice Address - Country:US
Practice Address - Phone:425-226-1422
Practice Address - Fax:425-226-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty