Active NPI
Pete B Higgins DDS LLC
- Dental Clinic/Center
- Fairbanks, AK
National Provider Identifier
1609055029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- License
- 1012
- Legal business name
- PETE B HIGGINS DDS LLC
- Practice address
- 4001 Geist Rd Ste 3
Fairbanks, AK 99709-3569 - Phone
- (907) 479-7771
- Fax
- (907) 479-7772
- NPI assigned
- Nov 1, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Pete B. Higgins, DDS
- Title
- Managing Member
- Phone
- (907) 479-7771
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 1012 | AK | Primary |
Addresses
Primary practice location
4001 Geist Rd Ste 3
Fairbanks, AK 99709-3569
Mailing address
4001 Geist Rd Ste 3
Fairbanks, AK 99709-3569
Phone (907) 479-7771
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD10122 | Medicaid | AK | |
| 1568540946 | Other | INDIVIDUAL NPI | |
| DD10121 | Medicaid | AK |
Other names 1
- Four Corners Dental Group
National Provider Directory
National Provider Directory- Tax ID family
- Four Corners Dental Group
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dental Clinic/Center
- Anchorage, AK
- NPI 1568540946
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193875200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193875200000",
"number": "1609055029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 GEIST RD STE 3",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093569",
"telephone_number": "907-479-7771",
"fax_number": "907-479-7772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 GEIST RD STE 3",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093569",
"telephone_number": "907-479-7771",
"fax_number": "907-479-7772"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PETE B HIGGINS DDS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-01",
"last_updated": "2007-11-01",
"status": "A",
"authorized_official_last_name": "HIGGINS",
"authorized_official_first_name": "PETE",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "907-479-7771",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "AK",
"license": "1012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD10122",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL NPI",
"identifier": "1568540946",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD10121",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Four Corners Dental Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.