Provider Demographics
NPI:1952119570
Name:HIGGINS LAKE DENTAL
Entity type:Organization
Organization Name:HIGGINS LAKE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-313-1674
Mailing Address - Street 1:315 W HIGGINS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-8733
Mailing Address - Country:US
Mailing Address - Phone:989-313-1674
Mailing Address - Fax:
Practice Address - Street 1:315 W HIGGINS LAKE DR
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-8733
Practice Address - Country:US
Practice Address - Phone:989-313-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental