Provider Demographics
NPI:1750300828
Name:HIGGINS, DONALD KEITH
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:KEITH
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:KEITH
Other - Last Name:HIGGINS
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2940 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4886
Mailing Address - Country:US
Mailing Address - Phone:505-471-6348
Mailing Address - Fax:
Practice Address - Street 1:2940 DURANGO DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4886
Practice Address - Country:US
Practice Address - Phone:505-471-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice