Provider Demographics
NPI:1548794043
Name:HIGHLAND LAKES DENTAL CENTER INC.
Entity Type:Organization
Organization Name:HIGHLAND LAKES DENTAL CENTER INC.
Other - Org Name:SCHMIDT AND BRUCE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-269-6921
Mailing Address - Street 1:550 E TIMBER DR STOP 3
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2894
Mailing Address - Country:US
Mailing Address - Phone:715-365-1777
Mailing Address - Fax:
Practice Address - Street 1:550 E TIMBER DR STOP 3
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2894
Practice Address - Country:US
Practice Address - Phone:715-365-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001473261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental