# LIGHTHOUSE DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174631287
- **Authorized official:** MR. MICHAEL LYNN HIGGINSON DDS (PARTNER/DENTIST)
- **Authorized official phone:** (208) 939-3010

## Contact information

- **Practice address:** 1177 N EAGLE RD, EAGLE, ID 83616
- **Practice address phone:** (208) 939-3010
- **Practice address fax:** (208) 939-3027
- **Mailing address:** 1177 N EAGLE RD, EAGLE, ID 83616
- **Mailing address phone:** (208) 939-3010
- **Mailing address fax:** (208) 939-3027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3380 | ID | Yes |
| 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