Organization
TODD HIGGINBOTHAM, PA
Active
Other names
higginbotham family dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE UGLEM (MANAGER)
(870) 539-6621
Entity
Organization
Contact information
Practice address
126 SOUTH MAIN STREET, LEACHVILLE, AR 72438
(870) 539-6621
(870) 539-6334
Mailing address
PO BOX 109, LEACHVILLE, AR 72438-0109
(870) 539-6621
(870) 539-6334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3393
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F953
BLUE CROSS BLUE SHIELD GROUP ID NUMBER
AR
Enumeration date
12/15/2008
Last updated
12/15/2008
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