Provider Demographics
NPI:1659529642
Name:HIGGINS, ANDREW LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEE
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 1:2000 HARBOR BLVD STE B100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2601
Mailing Address - Country:US
Mailing Address - Phone:949-444-5307
Mailing Address - Fax:
Practice Address - Street 1:2000 HARBOR BLVD STE B100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-444-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412140122300000X
WADE60538445122300000X
CA102739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist