Provider Demographics
NPI:1598988644
Name:KING & WIGGINS, D.M.D., P.A.
Entity Type:Organization
Organization Name:KING & WIGGINS, D.M.D., P.A.
Other - Org Name:CHARLESTON ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-569-1717
Mailing Address - Street 1:2170 ASHLEY PHOSPHATE RD.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4194
Mailing Address - Country:US
Mailing Address - Phone:843-569-1717
Mailing Address - Fax:843-569-6139
Practice Address - Street 1:2170 ASHLEY PHOSPHATE RD.
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4194
Practice Address - Country:US
Practice Address - Phone:843-569-1717
Practice Address - Fax:843-569-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ26632Medicaid