Organization · NPI-2

64 Highland Dental

Dentist, General Practice · Worcester, MA

NPI number1508195140

StatusActive

Last updated in NPPESMay 11, 2015

Details

NPI: 1508195140
Entity type: Organization (NPI-2)
Legal business name: 64 Highland Dental
Organization subpart: No
Enumeration date: Dec 10, 2009
Last updated: May 11, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223G0001X	Dentist, General Practice	–	–	Yes
1223G0001X	Dentist, General Practice	20028	MA
1223E0200X	Dentist, Endodontics	–	–
1223X0400X	Dentist, Orthodontics and Dentofacial Orthopedics	–	–
124Q00000X	Dental Hygienist	–	–

Practice location

64 Highland Street
Worcester, MA 01609

Phone 508-926-8660 · Fax 508-426-8667

Mailing address

64 Highland Street
Worcester, MA 01609

Phone 508-926-8660 · Fax 508-926-8667

Authorized official

John Miller
Owner
5089268660

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