Provider Demographics
NPI:1790359370
Name:HIGHLAND PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:HIGHLAND PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-985-3133
Mailing Address - Street 1:3506 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-1428
Mailing Address - Country:US
Mailing Address - Phone:219-985-3133
Mailing Address - Fax:
Practice Address - Street 1:2833 LINCOLN ST STE 1
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1957
Practice Address - Country:US
Practice Address - Phone:219-838-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty