Provider Demographics
NPI:1831268192
Name:HIGGINS, ALBERT MITCHEL (DDS)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:MITCHEL
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W GURLEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2852
Mailing Address - Country:US
Mailing Address - Phone:928-445-8033
Mailing Address - Fax:928-443-1373
Practice Address - Street 1:4025 W BELL RD
Practice Address - Street 2:SUITE #18
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2750
Practice Address - Country:US
Practice Address - Phone:602-843-1275
Practice Address - Fax:602-938-4910
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136673Medicaid