Provider Demographics
NPI:1144770181
Name:HIGH PLAINS DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:HIGH PLAINS DENTAL ASSOCIATES, PLLC
Other - Org Name:HIGH PLAINS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-272-5004
Mailing Address - Street 1:108 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3629
Mailing Address - Country:US
Mailing Address - Phone:806-272-5004
Mailing Address - Fax:806-272-5908
Practice Address - Street 1:108 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3629
Practice Address - Country:US
Practice Address - Phone:806-272-5004
Practice Address - Fax:806-272-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27957261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental