Provider Demographics
NPI:1225091911
Name:HIGGINBOTHAM, HENRY KESLER II (DDS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:KESLER
Last Name:HIGGINBOTHAM
Suffix:II
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 1:73 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5007
Mailing Address - Country:US
Mailing Address - Phone:540-980-8898
Mailing Address - Fax:
Practice Address - Street 1:73 3RD ST NW
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5007
Practice Address - Country:US
Practice Address - Phone:540-980-8898
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist