Provider Demographics
NPI:1548944291
Name:HIGHTOWER, TED ALLAN (DMD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:ALLAN
Last Name:HIGHTOWER
Suffix:
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 1:1300 SHETTER AVE APT 8201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3471
Mailing Address - Country:US
Mailing Address - Phone:502-718-2957
Mailing Address - Fax:
Practice Address - Street 1:50 FULKERSON WAY
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-0450
Practice Address - Country:US
Practice Address - Phone:904-770-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist