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General NPI Number Information
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NPI Number | 1174061790
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Entity Type | Organization
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Legal Business Name | HIGHBURY DENTAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 15661 W ROOSEVELT ST SUITE 102
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City | GOODYEAR
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State | AZ
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Zip | 85338-9307
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Country | US
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Telephone | 623-882-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 9201 EAGLE RANCH RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD ROWAN
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Credential |
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Telephone | 505-892-9010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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