Provider Demographics
NPI:1679786479
Name:HIGHBERGER, BRUCE CONRAD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CONRAD
Last Name:HIGHBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:BRUCE
Other - Middle Name:CONRAD
Other - Last Name:HIGHBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:138 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1326
Mailing Address - Country:US
Mailing Address - Phone:724-459-5640
Mailing Address - Fax:
Practice Address - Street 1:138 E MARKET ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1326
Practice Address - Country:US
Practice Address - Phone:724-459-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADF019413L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist