Basic Information
| Provider Information | |||||||||
| NPI: | 1902862709 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAX W HIGBEE DMD PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1765 SW PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977562550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415488175 | ||||||||
| FaxNumber: | 5415487025 | ||||||||
| Practice Location | |||||||||
| Address1: | 1765 SW PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977562550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415488175 | ||||||||
| FaxNumber: | 5415487025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | HIGBEE | ||||||||
| AuthorizedOfficialFirstName: | MAX | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 5415488175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D4439 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.