Provider Demographics
NPI:1336289826
Name:HIGGINS, RONALD G (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:HIGGINS
Suffix:
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:PO BOX 519
Mailing Address - Street 2:136 N GORIN
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-0519
Mailing Address - Country:US
Mailing Address - Phone:620-584-2223
Mailing Address - Fax:620-584-3348
Practice Address - Street 1:136 N GORIN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-0519
Practice Address - Country:US
Practice Address - Phone:620-584-2223
Practice Address - Fax:620-584-3348
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS008723OtherBLUE CROSS BLUE SHIELD OF