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General NPI Number Information
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NPI Number | 1275838237
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Entity Type | Organization
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Legal Business Name | MARCUS HIGGINS, DMD, PA
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 9041 SOUTHSIDE BLVD STE 176
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5484
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Country | US
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Telephone | 904-363-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 9041 SOUTHSIDE BLVD STE 176
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5484
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Country | US
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Telephone | 904-363-8813
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCUS HIGGINS
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Credential | DMD
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Telephone | 904-363-8813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17201
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License Number State | FL
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