Healthcare Provider Details

I. General information

NPI: 1942565486
Provider Name (Legal Business Name): JEFFREY W HIGBEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

1100 CANYON VIEW DR STE A
SANTA CLARA UT
84765-5672
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-4461
  • Fax: 401-456-4420
Mailing address:
  • Phone: 435-673-9922
  • Fax: 435-673-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberLD00080
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: