Provider Demographics
NPI:1164130332
Name:WEST HIGHLAND DENTAL LLC
Entity Type:Organization
Organization Name:WEST HIGHLAND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-646-5449
Mailing Address - Street 1:1904 SOUTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1964
Mailing Address - Country:US
Mailing Address - Phone:402-426-3334
Mailing Address - Fax:402-426-4540
Practice Address - Street 1:1904 SOUTH ST STE 103
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1964
Practice Address - Country:US
Practice Address - Phone:402-426-3334
Practice Address - Fax:402-426-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental