Provider Demographics
NPI:1962892653
Name:PDC HIGHLAND PARK LLC
Entity type:Organization
Organization Name:PDC HIGHLAND PARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RHET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHERSCHLIGT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-484-1032
Mailing Address - Street 1:3098 S HIGHLAND DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3618
Mailing Address - Country:US
Mailing Address - Phone:801-484-1032
Mailing Address - Fax:
Practice Address - Street 1:3098 S HIGHLAND DR STE 400
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3618
Practice Address - Country:US
Practice Address - Phone:801-484-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378380-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty