Healthcare Provider Details

I. General information

NPI: 1558456343
Provider Name (Legal Business Name): JAMES R HIGGINS DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 86TH ST SUITE 15
INDIANAPOLIS IN
46240-1801
US

IV. Provider business mailing address

1010 E 86TH ST SUITE 15
INDIANAPOLIS IN
46240-1801
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-3396
  • Fax: 317-844-4776
Mailing address:
  • Phone: 317-844-3396
  • Fax: 317-844-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12008992A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: