Lighthouse Dental Group

NPI #1174631287 in Eagle, Idaho

Provider Information

NPI Number: 1174631287
Entity Type: Organization
Organization Name: Lighthouse Dental Group
Primary Specialty: Dentist
Enumeration Date: Aug 28, 2006
Last Updated: Jan 12, 2010

Practice Location

Address: 1177 N EAGLE RD
City: Eagle
State: Idaho
ZIP Code: 83616
Phone: (208) 939-3010

Authorized Official

Name: MR. MICHAEL LYNN HIGGINSON, DDS
Title: PARTNER/DENTIST
Phone: (208) 939-3010

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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