Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5482 | KS |
NPI | 1003137316 |
---|---|
Provider Name | Dr. Scott Willis Wiggins |
First Address | Wichita, KS 67235-1224 |
Second Address | Wichita, KS 67235-1224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |