Provider Demographics
NPI:1467069427
Name:HIGHLAND FAMILY DENTAL PC
Entity Type:Organization
Organization Name:HIGHLAND FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMASHRIQI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-606-2226
Mailing Address - Street 1:8731 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1551
Mailing Address - Country:US
Mailing Address - Phone:708-606-2226
Mailing Address - Fax:
Practice Address - Street 1:8731 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1551
Practice Address - Country:US
Practice Address - Phone:708-606-2226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty