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General NPI Number Information
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NPI Number | 1942461405
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Entity Type | Organization
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Legal Business Name | HIGHLAND DENTAL LABORATORY, LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4054 MCKINNEY AVE STE 103
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City | DALLAS
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State | TX
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Zip | 75204-2050
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Country | US
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Telephone | 214-559-2292
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Fax | 214-559-2697
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Provider Business Mailing Address
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Address Line | 4054 MCKINNEY AVE STE 103
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City | DALLAS
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State | TX
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Zip | 75204-2050
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Country | US
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Telephone | 214-559-2292
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Fax | 214-559-2697
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. ANTHONY O SEMPRUN
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Credential |
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Telephone | 214-559-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | 0003065
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License Number State | TX
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