Provider Demographics
NPI:1255480968
Name:WIGHTMAN, FREDERICK CHARLES III (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:WIGHTMAN
Suffix:III
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 1:301 N HARRISON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3512
Mailing Address - Country:US
Mailing Address - Phone:609-924-0796
Mailing Address - Fax:609-924-7166
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3512
Practice Address - Country:US
Practice Address - Phone:609-924-0796
Practice Address - Fax:609-924-7166
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014261001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice