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NPI Code Detail

MEDICARE: SAMUEL J HIGDON DDS PC

MEDICARE: SAMUEL J HIGDON DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BC3200XCustomized Equipment (DME)

General Provider Information

NPI Number : 1467967372
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMUEL J HIGDON DDS PC
Provider Business Mailing Address
First Line : 2250 NW FLANDERS ST STE 111
Second Line :
City : PORTLAND
State : OR
Zip : 97210-5409
Country : US
Telephone Number : 503-227-4844
Fax Number :
Provider Business Practice Location Address
First Line : 2250 NW FLANDERS ST STE 111
Second Line :
City : PORTLAND
State : OR
Zip : 97210-5409
Country : US
Telephone Number : 503-227-4844
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SAMUEL HIGDON
Credential : DDS
Telephone Number : 503-227-4844
Provider Enumeration Date : 12/14/2017
Last Update Date : 12/14/2017

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Directions to “SAMUEL J HIGDON DDS PC ” Practice Location

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