Provider Demographics
NPI:1346505542
Name:HIGGINBOTHAM, MICHAEL RICHARD (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:113 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4670
Mailing Address - Country:US
Mailing Address - Phone:248-969-9500
Mailing Address - Fax:248-969-9509
Practice Address - Street 1:113 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4670
Practice Address - Country:US
Practice Address - Phone:248-969-9500
Practice Address - Fax:248-969-9509
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2020-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2901019840122300000X, 1223S0112X
MI4301101198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No208600000XAllopathic & Osteopathic PhysiciansSurgery