Provider Demographics
NPI:1942297510
Name:WIGGINS, RAYMOND L (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S MASON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3895
Mailing Address - Country:US
Mailing Address - Phone:281-395-1200
Mailing Address - Fax:281-395-1207
Practice Address - Street 1:810 S MASON RD
Practice Address - Street 2:STE 301
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3858
Practice Address - Country:US
Practice Address - Phone:281-395-1200
Practice Address - Fax:281-395-1207
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51107OtherASSURANT
TX509663782OtherUCCI
TX164989OtherDBP
TX88D134OtherBC/BS ID
TX51107OtherDHA