Provider Demographics
NPI:1801054911
Name:WIGGINS-SMITH, TARA LYNNETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNNETTE
Last Name:WIGGINS-SMITH
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 1:5050 KENTWORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5956
Mailing Address - Country:US
Mailing Address - Phone:919-599-2511
Mailing Address - Fax:
Practice Address - Street 1:5050 KENTWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-5956
Practice Address - Country:US
Practice Address - Phone:919-599-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist