Provider Demographics
NPI:1790099893
Name:TODD HIGGNBOTHAM, PA
Entity Type:Organization
Organization Name:TODD HIGGNBOTHAM, PA
Other - Org Name:HIGGINBOTHAM FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUEGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-8585
Mailing Address - Street 1:221 HIGHWAY 463 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-3503
Mailing Address - Country:US
Mailing Address - Phone:870-483-5011
Mailing Address - Fax:
Practice Address - Street 1:221 HIGHWAY 463 N
Practice Address - Street 2:SUITE B
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-3503
Practice Address - Country:US
Practice Address - Phone:870-483-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty