Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DEN014179 | MO |
NPI | 1013003284 |
---|---|
Provider Name | Sue E Higgins |
First Address | Lees Summit, MO 64086 |
Second Address | Lees Summit, MO 64086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |