Provider Demographics
NPI:1861414955
Name:HIGGINS, REBECCA T (DMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 ALTA CARMEL CT
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3893
Mailing Address - Country:US
Mailing Address - Phone:858-451-0908
Mailing Address - Fax:
Practice Address - Street 1:12125 ALTA CARMEL CT
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3893
Practice Address - Country:US
Practice Address - Phone:858-451-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist