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Organization
COSMETIC FAMILY DENTISTRY OF ROSWELL
Active
Organization
COSMETIC FAMILY DENTISTRY OF ROSWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH MORRIS WIGGINS JR. D.D.S. (PRESIDENT)
(770) 226-0008
Entity
Organization
Contact information
Practice address
1087 ALPHARETTA ST, ROSWELL, GA 30075-4483
(770) 650-0992
Mailing address
1087 ALPHARETTA ST, ROSWELL, GA 30075-4483
(770) 650-0992
(770) 650-0061
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN012484
GA
261QD0000X
Dental Clinic/Center
DN012485
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329140584A
—
GA
05
—
829858019A
—
GA
Enumeration date
08/26/2009
Last updated
08/26/2009
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