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Organization
LIGHTHOUSE DENTAL GROUP
Active
Organization
LIGHTHOUSE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LYNN HIGGINSON DDS (PARTNER/DENTIST)
(208) 939-3010
Entity
Organization
Contact information
Practice address
1177 N EAGLE RD, EAGLE, ID 83616
(208) 939-3010
(208) 939-3027
Mailing address
1177 N EAGLE RD, EAGLE, ID 83616
(208) 939-3010
(208) 939-3027
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3380
ID
122300000X
Dentist
D3878
ID
122300000X
Dentist
DRUG ID #BH6399857
ID
122300000X
Dentist
DRUG ID #BJ9304623
ID
Other
Enumeration date
08/28/2006
Last updated
01/12/2010
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