Provider Demographics
NPI:1003137316
Name:WIGGINS, SCOTT WILLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIS
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 NANTUCKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1224
Mailing Address - Country:US
Mailing Address - Phone:316-721-9885
Mailing Address - Fax:
Practice Address - Street 1:12105 NANTUCKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1224
Practice Address - Country:US
Practice Address - Phone:316-721-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist