Provider Demographics
NPI:1891166096
Name:RWIGEMA, JEAN-PAUL (DDS)
Entity type:Individual
Prefix:
First Name:JEAN-PAUL
Middle Name:
Last Name:RWIGEMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BLACKBURN ST
Mailing Address - Street 2:APT #308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2200
Mailing Address - Country:US
Mailing Address - Phone:602-573-9585
Mailing Address - Fax:
Practice Address - Street 1:3400 LOMBARDY LN
Practice Address - Street 2:SUITE #100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3310
Practice Address - Country:US
Practice Address - Phone:214-420-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist