Provider Demographics
NPI:1952401994
Name:WIGGINS, HOWELL E JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWELL
Middle Name:E
Last Name:WIGGINS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 N MAPLE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8006
Mailing Address - Country:US
Mailing Address - Phone:559-226-2722
Mailing Address - Fax:559-226-6989
Practice Address - Street 1:7025 N MAPLE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8006
Practice Address - Country:US
Practice Address - Phone:559-226-2722
Practice Address - Fax:559-226-6989
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21224122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD21224OtherREND. PROV. ID-DENTICAL
CAG92224-01OtherBILLING PROV. ID-DENTICAL
DS0212240Medicare ID - Type Unspecified
CAG92224-01OtherBILLING PROV. ID-DENTICAL