Provider Demographics
NPI:1548616501
Name:ANDREW HIGGINS D.D.S, PLLC
Entity Type:Organization
Organization Name:ANDREW HIGGINS D.D.S, PLLC
Other - Org Name:LAKE MERIDIAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-864-0821
Mailing Address - Street 1:17327 SE 270TH PL
Mailing Address - Street 2:SUITE 113
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5451
Mailing Address - Country:US
Mailing Address - Phone:253-455-7170
Mailing Address - Fax:
Practice Address - Street 1:17327 SE 270TH PL
Practice Address - Street 2:SUITE 113
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5451
Practice Address - Country:US
Practice Address - Phone:253-455-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60538445261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental