MEDICARE: MR. ALBERT MITCHEL HIGGINS 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	1223P0221X	Pediatric Dentistry	D4361	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831268192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT MITCHEL HIGGINS D.D.S.

Provider Business Mailing Address
First Line	:	1300 W GURLEY ST STE 1
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-2852
Country	:	US
Telephone Number	:	928-445-8033
Fax Number	:	928-443-1373

Provider Business Practice Location Address
First Line	:	4025 W BELL RD
Second Line	:	SUITE #18
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-843-1275
Fax Number	:	602-938-4910

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	11/01/2010

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