MEDICARE: BRYAN HAIGHT D.D.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669628913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN HAIGHT D.D.S., INC

Provider Business Mailing Address
First Line	:	1870 N MAIN ST
Second Line	:	SUITE 201
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-7744
Country	:	US
Telephone Number	:	435-586-9201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 N MAIN ST
Second Line	:	SUITE 201
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-7744
Country	:	US
Telephone Number	:	435-586-9201
Fax Number	:

Authorized Official
Title or Position	:	DR.
Name	:	BRYAN DREW HAIGHT
Credential	:
Telephone Number	:	435-586-9201

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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