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General NPI Number Information
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NPI Number | 1366406225
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Entity Type | Individual
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Provider Name | MARCUS A HIGGINS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 06/22/2023
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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 |
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Name |
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Credential |
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Telephone |
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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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