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General NPI Number Information
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NPI Number | 1184032484
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Entity Type | Organization
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Legal Business Name | DR WIGGLESWORTH, INC.
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 528 WATERWAY VILLAGE COURT
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City | GREENACRES
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State | FL
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Zip | 33413-0000
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Country | US
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Telephone | 602-865-9060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 542342
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City | GREENACRES
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State | FL
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Zip | 33454-0000
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Country | US
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Telephone | 602-865-9060
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Fax |
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | MS. DEANNA REBECCA WIGGLESWORTH
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Credential | DA
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Telephone | 602-865-9060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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