Organization
PETE B HIGGINS DDS LLC
Active
Other names
Four Corners Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETE B. HIGGINS DDS (MANAGING MEMBER)
(907) 479-7771
Entity
Organization
Contact information
Practice address
4001 GEIST RD STE 3, FAIRBANKS, AK 99709-3569
(907) 479-7771
(907) 479-7772
Mailing address
4001 GEIST RD STE 3, FAIRBANKS, AK 99709-3569
(907) 479-7771
(907) 479-7772
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1012
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568540946
INDIVIDUAL NPI
—
05
—
DD10121
—
AK
05
—
DD10122
—
AK
Enumeration date
11/01/2007
Last updated
11/01/2007
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