Healthcare Provider Details

I. General information

NPI: 1740403302
Provider Name (Legal Business Name): JOSEPH HALL HIGGINSON D.M.D.,M.S.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 FARRELL CRES
OWENSBORO KY
42303-1392
US

IV. Provider business mailing address

2868 FARRELL CRES
OWENSBORO KY
42303-1392
US

V. Phone/Fax

Practice location:
  • Phone: 270-684-0822
  • Fax: 270-683-3991
Mailing address:
  • Phone: 270-684-0822
  • Fax: 270-683-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: