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Individual

DR. ETHAN FOSTER HIGSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
HIGHWAY 191 & HOSPITAL DRIVE, CHINLE, AZ 86503
(928) 674-7001
Mailing address
PO BOX 2567, CHINLE, AZ 86503-2567

Taxonomy

Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
8877
KY
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/19/2010
Last updated
08/10/2011
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