Provider Demographics
NPI:1639753163
Name:HIGHLAND DRIVE DENTAL LLC
Entity Type:Organization
Organization Name:HIGHLAND DRIVE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZURCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-550-5013
Mailing Address - Street 1:6315 S COBBLECREST RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2254
Mailing Address - Country:US
Mailing Address - Phone:801-550-5013
Mailing Address - Fax:
Practice Address - Street 1:7240 S HIGHLAND DR STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6523
Practice Address - Country:US
Practice Address - Phone:801-550-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty