MEDICARE: HIGHLAND DENTAL ASSOCIATES, P.C.

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275268278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	11000 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2153
Country	:	US
Telephone Number	:	248-698-2220
Fax Number	:	248-698-0360

Provider Business Practice Location Address
First Line	:	11000 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2153
Country	:	US
Telephone Number	:	248-698-2220
Fax Number	:	248-698-0360

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. PATRICK LEVASSEUR LEVASSEUR
Credential	:	D.D.S.
Telephone Number	:	248-698-2220

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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