Provider Demographics
NPI:1215467444
Name:HIGGINS, BENJAMIN BARTON (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BARTON
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3720
Mailing Address - Country:US
Mailing Address - Phone:706-443-4028
Mailing Address - Fax:
Practice Address - Street 1:114 CALUMET CENTER RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-6703
Practice Address - Country:US
Practice Address - Phone:706-882-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist