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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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