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Organization
COSMETIC AND FAMILY DENTISTRY OF MARIETTA
Active
Organization
COSMETIC AND FAMILY DENTISTRY OF MARIETTA
Active
Parent organization
COSMETIC AND FAMILY DENTISTRY OF MARIETTA
Other names
Cosmetic and Family Dentistry of Roswell
Organization subpart
Yes
Provider details
NPI number
Legal business name
COSMETIC AND FAMILY DENTISTRY OF MARIETTA
Authorized official
DR. KENNETH MORRIS WIGGINS JR. DDS (DR./DENTIST)
(770) 226-0008
Entity
Organization
Contact information
Practice address
1611 SANDS PL SE STE 100, MARIETTA, GA 30067-8704
(770) 226-0008
(770) 226-0700
Mailing address
PO BOX 7718, MARIETTA, GA 30065-1718
(770) 226-0008
(770) 226-0700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN012484
GA
122300000X
Dentist
Primary
DN012485
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
829858019A
—
GA
05
—
829858019B
—
GA
Enumeration date
08/18/2008
Last updated
08/18/2008
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