Provider Demographics
NPI:1306577044
Name:HIGHLAND FAMILY DENTAL
Entity type:Organization
Organization Name:HIGHLAND FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-755-5431
Mailing Address - Street 1:229 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3055
Mailing Address - Country:US
Mailing Address - Phone:203-755-5431
Mailing Address - Fax:203-756-6089
Practice Address - Street 1:229 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3055
Practice Address - Country:US
Practice Address - Phone:203-755-5431
Practice Address - Fax:203-756-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental