Provider Demographics
NPI:1598976516
Name:HIGHLAND DENTAL DMD PC
Entity Type:Organization
Organization Name:HIGHLAND DENTAL DMD PC
Other - Org Name:HIGHLANT DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTEYNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-623-7474
Mailing Address - Street 1:366 BROADWAY
Mailing Address - Street 2:202
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2812
Mailing Address - Country:US
Mailing Address - Phone:617-623-7474
Mailing Address - Fax:617-591-9747
Practice Address - Street 1:366 BROADWAY
Practice Address - Street 2:202
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2812
Practice Address - Country:US
Practice Address - Phone:617-623-7474
Practice Address - Fax:617-591-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty