Provider Demographics
NPI:1528081312
Name:HIGGINS, PHILIP WAYNE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WAYNE
Last Name:HIGGINS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5375
Mailing Address - Country:US
Mailing Address - Phone:207-236-0899
Mailing Address - Fax:207-236-8338
Practice Address - Street 1:9 APPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5375
Practice Address - Country:US
Practice Address - Phone:207-236-0899
Practice Address - Fax:207-236-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME163510000Medicaid