Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8877 | KY |
NPI | 1497074231 |
---|---|
Provider Name | Dr. Ethan Foster Higson |
First Address | Chinle, AZ 86503-2567 |
Second Address | Chinle, AZ 86503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 10/08/2011 |