Provider Demographics
NPI:1245404318
Name:HIGHLAND MILLS DENTAL CARE
Entity Type:Organization
Organization Name:HIGHLAND MILLS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERHANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-928-3348
Mailing Address - Street 1:583 ROUTE 32
Mailing Address - Street 2:P.O. BOX 464
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5200
Mailing Address - Country:US
Mailing Address - Phone:845-928-3348
Mailing Address - Fax:
Practice Address - Street 1:583 ROUTE 32
Practice Address - Street 2:SUITE 1
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-5200
Practice Address - Country:US
Practice Address - Phone:845-928-3348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05273411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783535Medicaid
NY02749044Medicaid