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General NPI Number Information
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NPI Number | 1548794043
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Entity Type | Organization
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Legal Business Name | HIGHLAND LAKES DENTAL CENTER INC.
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 550 E TIMBER DR STOP 3
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City | RHINELANDER
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State | WI
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Zip | 54501-2894
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Country | US
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Telephone | 715-365-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 550 E TIMBER DR STOP 3
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City | RHINELANDER
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State | WI
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Zip | 54501-2894
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Country | US
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Telephone | 715-365-1777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA BRUCE
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Credential | DDS
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Telephone | 405-269-6921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1001473
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License Number State | WI
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