Provider Demographics
NPI:1669628913
Name:BRYAN HAIGHT D.D.S., INC
Entity Type:Organization
Organization Name:BRYAN HAIGHT D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:HAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-9201
Mailing Address - Street 1:1870 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7744
Mailing Address - Country:US
Mailing Address - Phone:435-586-9201
Mailing Address - Fax:
Practice Address - Street 1:1870 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7744
Practice Address - Country:US
Practice Address - Phone:435-586-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1114968831Medicaid