Healthcare Provider Details

I. General information

NPI: 1205421146
Provider Name (Legal Business Name): HIGHLAND DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HIGHLAND AVE
CHESHIRE CT
06410-2205
US

IV. Provider business mailing address

535 HIGHLAND AVE
CHESHIRE CT
06410-2205
US

V. Phone/Fax

Practice location:
  • Phone: 203-699-9705
  • Fax: 203-699-9222
Mailing address:
  • Phone: 203-699-9705
  • Fax: 203-699-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RENEE L KURTZ
Title or Position: OWNER
Credential: DMD
Phone: 203-699-9705