Provider Demographics
NPI:1013359553
Name:WIGGINS, CHELSEA E (DDS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2338
Mailing Address - Country:US
Mailing Address - Phone:402-551-2238
Mailing Address - Fax:
Practice Address - Street 1:5321 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2338
Practice Address - Country:US
Practice Address - Phone:402-551-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice