Provider Demographics
NPI:1275838237
Name:MARCUS HIGGINS, DMD, PA
Entity Type:Organization
Organization Name:MARCUS HIGGINS, DMD, PA
Other - Org Name:HIGGINS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-363-8813
Mailing Address - Street 1:9041 SOUTHSIDE BLVD
Mailing Address - Street 2:STE 176
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5484
Mailing Address - Country:US
Mailing Address - Phone:904-363-8813
Mailing Address - Fax:
Practice Address - Street 1:9041 SOUTHSIDE BLVD
Practice Address - Street 2:STE 176
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5484
Practice Address - Country:US
Practice Address - Phone:904-363-8813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty