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General NPI Number Information
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NPI Number | 1225242464
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Entity Type | Organization
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Legal Business Name | HIGHLAND FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1474 HIGHWAY 62 412
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City | HIGHLAND
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State | AR
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Zip | 72542-9170
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Country | US
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Telephone | 870-856-4050
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Fax | 870-856-4088
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Provider Business Mailing Address
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Address Line | 1474 HIGHWAY 62 412
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City | HIGHLAND
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State | AR
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Zip | 72542-9170
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Country | US
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Telephone | 870-856-4050
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Fax | 870-856-4088
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW GRANT WILLIAMS
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Credential | D.D.S.
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Telephone | 870-856-4050
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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 | 3392
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License Number State | TN
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