Provider Demographics
NPI:1013390996
Name:HIGHLAND DENTAL GROUP LLC
Entity Type:Organization
Organization Name:HIGHLAND DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-740-5135
Mailing Address - Street 1:100 HIGHLAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2702
Mailing Address - Country:US
Mailing Address - Phone:978-740-5135
Mailing Address - Fax:978-740-5105
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2702
Practice Address - Country:US
Practice Address - Phone:978-740-5135
Practice Address - Fax:978-740-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty