Provider Demographics
NPI:1184032484
Name:DR WIGGLESWORTH, INC.
Entity Type:Organization
Organization Name:DR WIGGLESWORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:WIGGLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DA
Authorized Official - Phone:602-865-9060
Mailing Address - Street 1:PO BOX 542342
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-0000
Mailing Address - Country:US
Mailing Address - Phone:602-865-9060
Mailing Address - Fax:
Practice Address - Street 1:528 WATERWAY VILLAGE COURT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-0000
Practice Address - Country:US
Practice Address - Phone:602-865-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty