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Organization
DENTISTRY '4' CHILDREN PLLC
Active
Organization
DENTISTRY '4' CHILDREN PLLC
Active
Other names
Dr Jeremy Wiggins
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURIE LESTER (OFFICE MANAGER)
(208) 743-2505
Entity
Organization
Contact information
Practice address
3326 4TH ST, SUITE 4, LEWISTON, ID 83501-4455
(208) 743-2505
(208) 746-6395
Mailing address
3326 4TH ST, SUITE 4, LEWISTON, ID 83501-4455
(208) 743-2505
(208) 746-6395
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3494
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806332400
—
ID
05
—
806496000
—
ID
Enumeration date
10/24/2005
Last updated
12/02/2010
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