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General NPI Number Information
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NPI Number | 1508087958
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Entity Type | Individual
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Provider Name | DEANTHIA ANGELA CHILDS-WIGGINS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 3220 COBB PKWY SE STE 205
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City | ATLANTA
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State | GA
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Zip | 30339-3895
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Country | US
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Telephone | 770-226-0008
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Fax | 770-226-0700
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Provider Business Mailing Address
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Address Line | PO BOX 7718
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City | MARIETTA
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State | GA
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Zip | 30065-1718
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Country | US
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Telephone | 770-226-0008
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Fax | 770-226-0700
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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 | DN012485
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License Number State | GA
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