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General NPI Number Information
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NPI Number | 1497089197
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Entity Type | Individual
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Provider Name | SHENEKIA AYANA WELLS WIGGINS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 3502 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39213-4454
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Country | US
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Telephone | 601-362-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 5207 MEADOW OAKS PARK DR
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City | JACKSON
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State | MS
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Zip | 39211-4820
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Country | US
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Telephone | 769-216-2913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3527-09
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License Number State | MS
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