Individual
DR. BRADLEY DAVID HIGGINBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 S 29TH ST, COUNCIL BLUFFS, IA 51501-3449
(712) 323-5801
(712) 388-0553
Mailing address
200 S 29TH ST, COUNCIL BLUFFS, IA 51501-3449
(712) 323-5801
(712) 388-0553
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6788
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196410
—
IA
Enumeration date
10/28/2006
Last updated
07/08/2007
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