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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