Healthcare Provider Details

I. General information

NPI: 1255409629
Provider Name (Legal Business Name): JOSEPH C WIGFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5371 STATE ROUTE 183 NE
MAGNOLIA OH
44643
US

IV. Provider business mailing address

5371 STATE ROUTE 183 NE
MAGNOLIA OH
44643
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-5555
  • Fax: 330-866-1800
Mailing address:
  • Phone: 330-866-5555
  • Fax: 330-866-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30021486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: