Provider Demographics
NPI:1063475796
Name:HIGA, BRIAN M (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:HIGA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HAILI STREET
Mailing Address - Street 2:BLDG B
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:808-961-4071
Mailing Address - Fax:808-961-5167
Practice Address - Street 1:16-192 PILIMUA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-930-0418
Practice Address - Fax:808-961-5167
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI571176Medicaid
HI2109OtherHDS
HI0000251041OtherHMSA