Provider Demographics
NPI:1427796374
Name:WIGGINS, BROOKE ELIZABETH CICERO (DMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH CICERO
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FLEETS ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9033
Mailing Address - Country:US
Mailing Address - Phone:727-946-3020
Mailing Address - Fax:
Practice Address - Street 1:4850 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7674
Practice Address - Country:US
Practice Address - Phone:870-630-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X122300000X
AR1291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist