# DENTISTRY '4' CHILDREN PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Dr Jeremy Wiggins
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902896772
- **Authorized official:** MS. LAURIE LESTER (OFFICE MANAGER)
- **Authorized official phone:** (208) 743-2505

## Contact information

- **Practice address:** 3326 4TH ST, SUITE 4, LEWISTON, ID 83501-4455
- **Practice address phone:** (208) 743-2505
- **Practice address fax:** (208) 746-6395
- **Mailing address:** 3326 4TH ST, SUITE 4, LEWISTON, ID 83501-4455
- **Mailing address phone:** (208) 743-2505
- **Mailing address fax:** (208) 746-6395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3494 | ID | Yes |

## Other

- **Enumeration date:** 10/24/2005
- **Last updated:** 12/02/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 806332400 | — | ID |
| 05 | — | 806496000 | — | ID |