Provider Demographics
NPI:1235140518
Name:HIGGINS, ELLIOTT B (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:B
Last Name:HIGGINS
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 1:511 MARINE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5832
Mailing Address - Country:US
Mailing Address - Phone:303-938-8743
Mailing Address - Fax:
Practice Address - Street 1:2575 PEARL ST STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3818
Practice Address - Country:US
Practice Address - Phone:303-443-3771
Practice Address - Fax:303-443-3611
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice