Provider Demographics
NPI:1962411421
Name:WIGGINS, CURTIS E (DDS)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:E
Last Name:WIGGINS
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 1:3326 4TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4455
Mailing Address - Country:US
Mailing Address - Phone:208-743-2505
Mailing Address - Fax:208-746-6395
Practice Address - Street 1:3326 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4455
Practice Address - Country:US
Practice Address - Phone:208-743-2505
Practice Address - Fax:208-746-6395
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD17941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001904900Medicaid