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General NPI Number Information
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NPI Number | 1710093992
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Entity Type | Organization
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Legal Business Name | ALPHA OMEGA DENTAL CENTER PLLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/03/2024
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Provider Practice Location Address
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Address Line | 1550 COMMERCE DR
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City | MARQUETTE
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State | MI
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Zip | 49855-8640
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Country | US
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Telephone | 906-225-1100
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Fax | 906-225-0889
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Provider Business Mailing Address
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Address Line | 1550 COMMERCE DR
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City | MARQUETTE
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State | MI
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Zip | 49855-8640
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Country | US
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Telephone | 906-225-1100
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Fax | 906-225-0889
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Authorized Official
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Title or Position | OWNER - SOLE MEMBER
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Name | DR. CYNTHIA MAE WIGGINS
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Credential | DDS
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Telephone | 906-225-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901016962
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License Number State | MI
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