Healthcare Provider Details

I. General information

NPI: 1861416570
Provider Name (Legal Business Name): JEFFERY THOMAS HIGGS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HERITAGE DR
DRESDEN TN
38225-4374
US

IV. Provider business mailing address

145 HERITAGE DR
DRESDEN TN
38225-4374
US

V. Phone/Fax

Practice location:
  • Phone: 731-364-6966
  • Fax: 731-364-5339
Mailing address:
  • Phone: 731-364-6966
  • Fax: 731-364-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS5184
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: