Provider Demographics
NPI:1073774360
Name:W. CLARK HIGGS, D.D.S.
Entity Type:Organization
Organization Name:W. CLARK HIGGS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:HIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-859-2000
Mailing Address - Street 1:85 CUDE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2292
Mailing Address - Country:US
Mailing Address - Phone:615-859-2000
Mailing Address - Fax:615-859-8902
Practice Address - Street 1:85 CUDE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2292
Practice Address - Country:US
Practice Address - Phone:615-859-2000
Practice Address - Fax:615-859-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS76091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty