Provider Demographics
NPI:1700459708
Name:HIGGINBOTHAM, REID (MS, DMD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 QUAIL CREEK CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6410
Mailing Address - Country:US
Mailing Address - Phone:901-848-9465
Mailing Address - Fax:
Practice Address - Street 1:775 E BROOKHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4501
Practice Address - Country:US
Practice Address - Phone:901-614-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN116771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice