Provider Demographics
NPI:1033675400
Name:HIGHBURY DENTAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HIGHBURY DENTAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-313-3088
Mailing Address - Street 1:2218 E WILLIAMS FIELD RD STE 260
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0779
Mailing Address - Country:US
Mailing Address - Phone:602-313-8033
Mailing Address - Fax:480-718-7341
Practice Address - Street 1:40930 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-8915
Practice Address - Country:US
Practice Address - Phone:602-313-8033
Practice Address - Fax:480-718-7341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHBURY DENTAL MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty