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General NPI Number Information
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NPI Number | 1144345489
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Entity Type | Organization
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Legal Business Name | HIGHLAND DENTAL GROUP, INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1189 SMITHFIELD AVE
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City | LINCOLN
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State | RI
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Zip | 02865-2517
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Country | US
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Telephone | 401-728-6350
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Fax | 401-728-3917
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Provider Business Mailing Address
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Address Line | 1189 SMITHFIELD AVE
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City | LINCOLN
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State | RI
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Zip | 02865-2517
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Country | US
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Telephone | 401-728-6350
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Fax | 401-728-3917
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY M. FORTI
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Credential | D.D.S.
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Telephone | 401-728-6350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | LF2168
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License Number State | RI
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