Provider Demographics
NPI:1083817878
Name:WIGHTMAN, ANDREW P (DMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:P
Last Name:WIGHTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6050 TACOMA MALL BLVD, SUITE 330
Mailing Address - Street 2:
Mailing Address - City:TOCOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-473-0651
Mailing Address - Fax:253-444-0761
Practice Address - Street 1:6050 TACOMA MALL BLVD SUITE 330
Practice Address - Street 2:
Practice Address - City:TOCOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-473-0651
Practice Address - Fax:253-444-0761
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603253501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery