Healthcare Provider Details

I. General information

NPI: 1962920330
Provider Name (Legal Business Name): HIGHLAND ORAL APPLIANCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E HIGHLAND RD
HIGHLAND MI
48356-2810
US

IV. Provider business mailing address

2950 E HIGHLAND RD
HIGHLAND MI
48356-2810
US

V. Phone/Fax

Practice location:
  • Phone: 248-206-0087
  • Fax:
Mailing address:
  • Phone: 248-206-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number290113027
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES EDWARD LOCASCIO
Title or Position: OWNER
Credential: DDS
Phone: 248-717-3410