Provider Demographics
NPI:1922262435
Name:HIGGINBOTHAM, LAWRENCE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:HIGGINBOTHAM
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 1:50 HUMPHREYS CTR
Mailing Address - Street 2:SUITE 39
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2368
Mailing Address - Country:US
Mailing Address - Phone:901-747-4611
Mailing Address - Fax:901-747-4636
Practice Address - Street 1:50 HUMPHREYS CTR
Practice Address - Street 2:SUITE 39
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2368
Practice Address - Country:US
Practice Address - Phone:901-747-4611
Practice Address - Fax:901-747-4636
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS41641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice