Provider Demographics
NPI:1366406225
Name:HIGGINS, MARCUS A (DMD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:A
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 1:9041 SOUTHSIDE BLVD
Mailing Address - Street 2:STE 176
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5484
Mailing Address - Country:US
Mailing Address - Phone:904-363-8813
Mailing Address - Fax:
Practice Address - Street 1:9041 SOUTHSIDE BLVD
Practice Address - Street 2:STE 176
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5484
Practice Address - Country:US
Practice Address - Phone:904-363-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist