Provider Demographics
NPI:1912637950
Name:MICHAEL D HAIGHT DDS PC
Entity Type:Organization
Organization Name:MICHAEL D HAIGHT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-298-7479
Mailing Address - Street 1:10409 MONTGOMERY PKWY NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3862
Mailing Address - Country:US
Mailing Address - Phone:505-298-7479
Mailing Address - Fax:505-296-4278
Practice Address - Street 1:10409 MONTGOMERY PKWY NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3862
Practice Address - Country:US
Practice Address - Phone:505-298-7479
Practice Address - Fax:505-296-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD1845OtherDENTAL LICENSE
NM1710019047OtherNPI