Provider Demographics
NPI:1013002021
Name:HIGGINS, JOHN WAITE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAITE
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 NORTHWEST BLVD
Mailing Address - Street 2:RIVERSIDE MEDICAL PLAZA I SUITE 5
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410
Mailing Address - Country:US
Mailing Address - Phone:361-387-3442
Mailing Address - Fax:361-387-3896
Practice Address - Street 1:13725 NORTHWEST BLVD
Practice Address - Street 2:RIVERSIDE MEDICAL PLAZA I SUITE 5
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-387-3442
Practice Address - Fax:361-387-3896
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist