Healthcare Provider Details

I. General information

NPI: 1205829538
Provider Name (Legal Business Name): JOHN C WIGER DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42697 RED SHALE CT
ASHBURN VA
20148-4107
US

IV. Provider business mailing address

42697 RED SHALE CT
ASHBURN VA
20148-4107
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-8898
  • Fax: 703-880-7006
Mailing address:
  • Phone: 703-729-8898
  • Fax: 703-880-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number041007620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: