NPIMap

Organization Active NPI

Higginbotham Dental Group, PLLC

  • General Practice Dentistry
  • Memphis, TN
National Provider Identifier
1457717381
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HIGGINBOTHAM DENTAL GROUP, PLLC
Practice address
113 Harbor Town SQ Ste 203
Memphis, TN 38103-8890
Phone
(901) 453-6081
Fax
(901) 453-6083
NPI assigned
Jan 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Misti Ross
Title
Insurance Director
Phone
(870) 336-3732

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 10169 TN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

113 Harbor Town SQ Ste 203
Memphis, TN 38103-8890

Mailing address

1804 Old Greensboro Rd BLDG B
Jonesboro, AR 72405-0003
Phone (870) 336-5620

Other practice location 1

6630 Summer Knoll Cir Ste 103
Bartlett, TN 38134-2926
Phone (901) 377-5060

Other practice location 2

7685 Wolf River Cir Ste 101
Germantown, TN 38138-1749
Phone (901) 753-2225

Other practice location 3

5100 Wheelis Dr Ste 214
Memphis, TN 38117-4541
Phone (901) 767-1610

Other names 1

  • Higginbotham Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Higginbotham Dental Group PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6630 Summer Knoll Cir
Ste 103
Bartlett, TN 38134
Phone (901) 377-5060

7685 Wolf River Cir
Ste 101
Germantown, TN 38138
Phone (901) 753-2225

5100 Wheelis Dr
Ste 214
Memphis, TN 38117
Phone (901) 767-1610

113 Harbor Town Sq
Ste 203
Memphis, TN 38103
Phone (901) 453-6081

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1457717381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 OLD GREENSBORO RD BLDG B",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724050003",
            "telephone_number": "870-336-5620",
            "fax_number": "870-336-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 HARBOR TOWN SQ STE 203",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381038890",
            "telephone_number": "901-453-6081",
            "fax_number": "901-453-6083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6630 Summer Knoll Cir Ste 103",
            "address_purpose": "LOCATION",
            "city": "Bartlett",
            "state": "TN",
            "postal_code": "381342926",
            "country_code": "US",
            "telephone_number": "901-377-5060",
            "fax_number": "901-382-5181",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7685 Wolf River Cir Ste 101",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381381749",
            "country_code": "US",
            "telephone_number": "901-753-2225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5100 Wheelis Dr Ste 214",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381174541",
            "country_code": "US",
            "telephone_number": "901-767-1610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HIGGINBOTHAM DENTAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "MISTI",
        "authorized_official_title_or_position": "INSURANCE DIRECTOR",
        "authorized_official_telephone_number": "870-336-3732"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "10169",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Higginbotham Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.