MEDICARE: DR. RAYMOND L WIGGINS D.D.S., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	18986	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51107	OTHER	TX	ASSURANT
2	509663782	OTHER	TX	UCCI
3	164989	OTHER	TX	DBP
4	88D134	OTHER	TX	BC/BS ID
5	51107	OTHER	TX	DHA

General Provider Information

NPI Number	:	1942297510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND L WIGGINS D.D.S., M.D.

Provider Business Mailing Address
First Line	:	810 S MASON RD
Second Line	:	SUITE 301
City	:	KATY
State	:	TX
Zip	:	77450-3895
Country	:	US
Telephone Number	:	281-395-1200
Fax Number	:	281-395-1207

Provider Business Practice Location Address
First Line	:	810 S MASON RD
Second Line	:	STE 301
City	:	KATY
State	:	TX
Zip	:	77450-3858
Country	:	US
Telephone Number	:	281-395-1200
Fax Number	:	281-395-1207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/05/2013

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Directions to “ DR. RAYMOND L WIGGINS D.D.S., M.D.” Practice Location

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