Provider Demographics
NPI:1164648200
Name:WIGGINS, CYNTHIA MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MAE
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 1:1550 COMMERCE DR.
Mailing Address - Street 2:ALPHA OMEGA DENTAL CENTER
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-1100
Mailing Address - Fax:
Practice Address - Street 1:1550 COMMERCE DR
Practice Address - Street 2:ALPHA OMEGA DENTAL CENTER
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8640
Practice Address - Country:US
Practice Address - Phone:906-225-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0169621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI016962OtherSTATE LICENSE ID NO.