Provider Demographics
NPI:1508849555
Name:HIGGS, WILSON CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:CLARK
Last Name:HIGGS
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 1:3102 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3673
Mailing Address - Country:US
Mailing Address - Phone:615-859-2000
Mailing Address - Fax:615-528-5293
Practice Address - Street 1:3102 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3673
Practice Address - Country:US
Practice Address - Phone:615-859-2000
Practice Address - Fax:615-528-5293
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS76091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry