Provider Demographics
NPI:1740480847
Name:CLIFTON C. HIGGINS, D.D.S., P.A.
Entity type:Organization
Organization Name:CLIFTON C. HIGGINS, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RDA
Authorized Official - Phone:870-935-7979
Mailing Address - Street 1:820 E MATTHEWS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3048
Mailing Address - Country:US
Mailing Address - Phone:870-931-3377
Mailing Address - Fax:870-931-3377
Practice Address - Street 1:820 E MATTHEWS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3048
Practice Address - Country:US
Practice Address - Phone:870-931-3377
Practice Address - Fax:870-931-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F847OtherARKANSAS BCBS