Provider Demographics
NPI:1609205525
Name:ELLIOTT B. HIGGINS D.M.D. P.C.
Entity Type:Organization
Organization Name:ELLIOTT B. HIGGINS D.M.D. P.C.
Other - Org Name:PEARL STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-443-3771
Mailing Address - Street 1:2575 PEARL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3868
Mailing Address - Country:US
Mailing Address - Phone:303-443-3177
Mailing Address - Fax:303-443-3611
Practice Address - Street 1:2575 PEARL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3868
Practice Address - Country:US
Practice Address - Phone:303-443-3177
Practice Address - Fax:303-443-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty