Organization
JORDAN E. HIGHAM PA
Active
Other names
Just 4 kiDDS Dentistry For Children
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN ELLISON HIGHAM DDS (OWNER/DENTIST)
(208) 529-2199
Entity
Organization
Contact information
Practice address
929 S UTAH AVE, IDAHO FALLS, ID 83402-3322
(208) 529-2199
Mailing address
929 S UTAH AVE, IDAHO FALLS, ID 83402-3322
(208) 529-2199
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-4205-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710186432
SOLO PRACTICE NPI
ID
Enumeration date
05/13/2013
Last updated
05/13/2013
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