MEDICARE: HIGHLAND DENTAL CENTER, PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1922378926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND DENTAL CENTER, PC

Provider Business Mailing Address
First Line	:	1955 S 1300 E
Second Line	:	SUITE #1
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3658
Country	:	US
Telephone Number	:	801-487-5755
Fax Number	:	801-484-5567

Provider Business Practice Location Address
First Line	:	1955 S 1300 E
Second Line	:	SUITE #1
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3658
Country	:	US
Telephone Number	:	801-487-5755
Fax Number	:	801-484-5567

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD BRUCE BARNES
Credential	:	DDS
Telephone Number	:	801-487-5755

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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