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NPI Code Detail

MEDICARE: SOUTHERN HIGHLANDS DENTAL, LLC

MEDICARE: SOUTHERN HIGHLANDS DENTAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryS6-81NV

General Provider Information

NPI Number : 1003107103
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN HIGHLANDS DENTAL, LLC
Provider Business Mailing Address
First Line : 526 S TONOPAH DR
Second Line : SUITE 200
City : LAS VEGAS
State : NV
Zip : 89106-4043
Country : US
Telephone Number : 702-435-5015
Fax Number : 702-366-1483
Provider Business Practice Location Address
First Line : 10660 SOUTHERN HIGHLANDS PKWY
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89141-4114
Country : US
Telephone Number : 702-472-7290
Fax Number : 702-366-1483
Authorized Official
Title or Position : OWNER
Name : GURBRINDER DHILLON
Credential :
Telephone Number : 702-472-7290
Provider Enumeration Date : 04/22/2011
Last Update Date : 04/22/2011

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Directions to “SOUTHERN HIGHLANDS DENTAL, LLC ” Practice Location

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