=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376868398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WIGGINS & GILES, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2010
-----------------------------------------------------
Last Update Date | 04/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5050 KENTWORTH DR
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-7690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-567-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5050 KENTWORTH DR
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-7690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-567-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/PARTNER
-----------------------------------------------------
Name | DR. JENINE GILES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-301-6157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8595
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8604
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------