Provider Demographics
NPI:1346694924
Name:WIGGINS, SAMUEL MYLES (DMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MYLES
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ALISON DR STE 9
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4410
Mailing Address - Country:US
Mailing Address - Phone:256-234-5003
Mailing Address - Fax:
Practice Address - Street 1:125 ALISON DR STE 9
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4410
Practice Address - Country:US
Practice Address - Phone:256-234-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL63081223G0001X
AL6308 C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice