Provider Demographics
NPI:1013681741
Name:BLAKE HIGGINS DDS PLLC
Entity type:Organization
Organization Name:BLAKE HIGGINS DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-390-4662
Mailing Address - Street 1:2055 VERMONT RD
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-3802
Mailing Address - Country:US
Mailing Address - Phone:970-390-4662
Mailing Address - Fax:
Practice Address - Street 1:105 EDWARDS VILLAGE BLVD UNIT 202
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-3211
Practice Address - Country:US
Practice Address - Phone:970-926-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty