Healthcare Provider Details

I. General information

NPI: 1558381962
Provider Name (Legal Business Name): DR. ANGELA DENISE WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 JENNY LIND RD STE 6A
FORT SMITH AR
72908-8641
US

IV. Provider business mailing address

8901 JENNY LIND RD STE 6A
FORT SMITH AR
72908-8641
US

V. Phone/Fax

Practice location:
  • Phone: 479-648-8844
  • Fax: 479-648-9288
Mailing address:
  • Phone: 479-648-8844
  • Fax: 479-648-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: