Provider Demographics
NPI:1942565486
Name:HIGBEE, JEFFREY W (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HIGBEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CANYON VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5672
Mailing Address - Country:US
Mailing Address - Phone:435-673-9922
Mailing Address - Fax:435-673-9411
Practice Address - Street 1:21 PEACE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1510
Practice Address - Country:US
Practice Address - Phone:401-456-4461
Practice Address - Fax:401-456-4420
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILD000801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILD00080OtherLICENSE NUMBER