Provider Demographics
NPI:1093032419
Name:HIGHLANDS DENTAL, LLC
Entity Type:Organization
Organization Name:HIGHLANDS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-771-1301
Mailing Address - Street 1:3000 VILLAGE RUN RD
Mailing Address - Street 2:SUITE 103-107
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6315
Mailing Address - Country:US
Mailing Address - Phone:724-771-1301
Mailing Address - Fax:
Practice Address - Street 1:2024 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-5354
Practice Address - Country:US
Practice Address - Phone:724-771-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty