Healthcare Provider Details

I. General information

NPI: 1679774434
Provider Name (Legal Business Name): FIANNA FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 JENNY LIND RD STE 6A
FORT SMITH AR
72908-8627
US

IV. Provider business mailing address

8901 JENNY LIND RD STE 6A
FORT SMITH AR
72908-8627
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 Code305S00000X
TaxonomyPoint of Service
License Number3005
License Number StateAR

VIII. Authorized Official

Name: DR. ANGELA DENISE WIGGINS
Title or Position: OWNER
Credential:
Phone: 479-648-8844