Provider Demographics
NPI:1508087958
Name:CHILDS-WIGGINS, DEANTHIA ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEANTHIA
Middle Name:ANGELA
Last Name:CHILDS-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:PO BOX 7718
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-1718
Mailing Address - Country:US
Mailing Address - Phone:770-226-0008
Mailing Address - Fax:770-226-0700
Practice Address - Street 1:3220 COBB PKWY SE STE 205
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3895
Practice Address - Country:US
Practice Address - Phone:770-226-0008
Practice Address - Fax:770-226-0700
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012485122300000X
OH20712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA329140584AMedicaid
GA329140584AMedicaid