Provider Demographics
NPI:1851548994
Name:HIGHLAND DMD CORP
Entity Type:Organization
Organization Name:HIGHLAND DMD CORP
Other - Org Name:DENTISTRY IN THE HIGHLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-676-8268
Mailing Address - Street 1:673 ROBESON ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5425
Mailing Address - Country:US
Mailing Address - Phone:508-676-8268
Mailing Address - Fax:508-677-4929
Practice Address - Street 1:673 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5425
Practice Address - Country:US
Practice Address - Phone:508-676-8268
Practice Address - Fax:508-677-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609907823OtherDELTA DENTAL OF MASS