Provider Demographics
NPI:1396514899
Name:HIGH BRIDGE PERIODONTICS LLC
Entity type:Organization
Organization Name:HIGH BRIDGE PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:608-817-3252
Mailing Address - Street 1:2921 LANDMARK PL STE 215
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4248
Mailing Address - Country:US
Mailing Address - Phone:608-817-3252
Mailing Address - Fax:
Practice Address - Street 1:3203 STEIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6946
Practice Address - Country:US
Practice Address - Phone:715-835-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERRY TREE DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty