Provider Demographics
NPI:1518163583
Name:HIGH MESA DENTAL ARTS
Entity Type:Organization
Organization Name:HIGH MESA DENTAL ARTS
Other - Org Name:ROGER C GARTZ DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-672-1336
Mailing Address - Street 1:106A LONGVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3738
Mailing Address - Country:US
Mailing Address - Phone:505-672-1336
Mailing Address - Fax:505-672-0840
Practice Address - Street 1:106A LONGVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3738
Practice Address - Country:US
Practice Address - Phone:505-672-1336
Practice Address - Fax:505-672-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR9365Medicaid