Provider Demographics
NPI:1316023443
Name:HIGGINS, MANI & WATSON IV DDS PA
Entity Type:Organization
Organization Name:HIGGINS, MANI & WATSON IV DDS PA
Other - Org Name:HARROLD, HIGGINS, MANI & WATSON IV DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-938-0525
Mailing Address - Street 1:545 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4767
Mailing Address - Country:US
Mailing Address - Phone:919-938-0525
Mailing Address - Fax:919-938-0544
Practice Address - Street 1:545 VENTURE DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4767
Practice Address - Country:US
Practice Address - Phone:919-938-0525
Practice Address - Fax:919-938-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904151Medicaid