NPIMap

Organization Active NPI

Lighthouse Dental Group

  • Dentist
  • Eagle, ID
National Provider Identifier
1174631287
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3380 Issued in ID
Legal business name
LIGHTHOUSE DENTAL GROUP
Practice address
1177 N Eagle Rd
Eagle, ID 83616
Phone
(208) 939-3010
Fax
(208) 939-3027
NPI assigned
Aug 28, 2006
Last updated
Jan 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Lynn Higginson, DDSNPI 1912172503
Title
Partner/Dentist
Phone
(208) 939-3010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3380 ID Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DRUG ID #BH6399857 ID
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3878 ID
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DRUG ID #BJ9304623 ID

Addresses

Primary practice location

1177 N Eagle Rd
Eagle, ID 83616

Mailing address

1177 N Eagle Rd
Eagle, ID 83616
Phone (208) 939-3010

National Provider Directory

National Provider Directory

Locations

1177 N Eagle Rd
Eagle, ID 83616
Phone (208) 939-3010

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1174631287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 N EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-939-3010",
            "fax_number": "208-939-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 N EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-939-3010",
            "fax_number": "208-939-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "HIGGINSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PARTNER/DENTIST",
        "authorized_official_telephone_number": "208-939-3010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3380",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "DRUG ID #BH6399857",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3878",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "DRUG ID #BJ9304623",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.