Doctor Name: | DR. JORDAN HIGHAM |
NPI Number: | 1710186432 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | |
Business Practice Address: | 929 S Utah Ave Idaho Falls, ID - 834023322 |
Business Phone Number: | 2085292199 |
Business Fax Number: | |
Mailing Address: | 370 N State St, Box 683 SHELLEY |
State: | ID |
Postal Code: | 832741141 |
Phone Number: | 2083608540 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2007 |
NPI Last Update Date: | 05/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |