MEDICARE: DR. DEANTHIA ANGELA CHILDS-WIGGINS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN012485	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508087958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANTHIA ANGELA CHILDS-WIGGINS D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 7718
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30065-1718
Country	:	US
Telephone Number	:	770-226-0008
Fax Number	:	770-226-0700

Provider Business Practice Location Address
First Line	:	3220 COBB PKWY SE STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3895
Country	:	US
Telephone Number	:	770-226-0008
Fax Number	:	770-226-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	12/20/2021

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