Provider Demographics
NPI:1265424311
Name:HIGGERSON, BRAD A (DMD)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:A
Last Name:HIGGERSON
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 1:9018 NORTH SKYVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154
Mailing Address - Country:US
Mailing Address - Phone:816-741-5113
Mailing Address - Fax:816-741-5121
Practice Address - Street 1:9018 NORTH SKYVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154
Practice Address - Country:US
Practice Address - Phone:816-741-5113
Practice Address - Fax:816-741-5121
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-03-16
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
KS70981223G0001X
MO20120345631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice