Provider Demographics
NPI:1831465293
Name:WIGGINS, TERA HARRISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERA
Middle Name:HARRISON
Last Name: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 1:3613 EAGLE POINT LN
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7395
Mailing Address - Country:US
Mailing Address - Phone:252-674-1188
Mailing Address - Fax:
Practice Address - Street 1:545 VENTURE DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4779
Practice Address - Country:US
Practice Address - Phone:919-938-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50056977122300000X
NC10529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist