Provider Demographics
NPI:1588867337
Name:HUGGINS, JOHN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:HUGGINS
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 1:2155 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5223
Mailing Address - Country:US
Mailing Address - Phone:662-234-5222
Mailing Address - Fax:662-234-5254
Practice Address - Street 1:2155 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5223
Practice Address - Country:US
Practice Address - Phone:662-234-5222
Practice Address - Fax:662-234-5254
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2825-94122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0660083Medicaid