Provider Demographics
NPI:1295359370
Name:HIGHLAND DENTAL GROUP
Entity Type:Organization
Organization Name:HIGHLAND DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-355-3898
Mailing Address - Street 1:830 W AVENUE L STE 129
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7210
Mailing Address - Country:US
Mailing Address - Phone:661-418-0266
Mailing Address - Fax:661-418-0281
Practice Address - Street 1:830 W AVENUE L STE 129
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7210
Practice Address - Country:US
Practice Address - Phone:661-418-0066
Practice Address - Fax:661-418-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285751057Medicaid
CA1336461789Medicaid