Provider Demographics
NPI:1093001158
Name:WIGNALL, STEWART P (DDS)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:P
Last Name:WIGNALL
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 1:1502 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2837
Mailing Address - Country:US
Mailing Address - Phone:919-942-8880
Mailing Address - Fax:919-942-5961
Practice Address - Street 1:1502 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2837
Practice Address - Country:US
Practice Address - Phone:919-942-8880
Practice Address - Fax:919-942-5961
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist