Provider Demographics
NPI:1740425800
Name:HIGGINS, MANI & WATSON V DDS PA
Entity Type:Organization
Organization Name:HIGGINS, MANI & WATSON V DDS PA
Other - Org Name:HARROLD, HIGGINS, MANI & WATSON V DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-479-1300
Mailing Address - Street 1:3901 N ROXBORO ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2181
Mailing Address - Country:US
Mailing Address - Phone:919-479-1300
Mailing Address - Fax:919-479-1400
Practice Address - Street 1:3901 N ROXBORO ST STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-1300
Practice Address - Fax:919-479-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950637Medicaid