MEDICARE: DR. SAMUEL HIGDON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3965	OR

General Provider Information

NPI Number	:	1295796738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL HIGDON D.D.S.

Provider Business Mailing Address
First Line	:	2250 NW FLANDERS ST
Second Line	:	STE 111
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-227-4844
Fax Number	:	503-243-1716

Provider Business Practice Location Address
First Line	:	2250 NW FLANDERS ST
Second Line	:	STE 111
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-227-4844
Fax Number	:	503-243-1716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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