Individual
JEREMY C WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3326 4TH ST STE 4, LEWISTON, ID 83501-4455
(208) 743-2505
(208) 746-6395
Mailing address
3326 4TH ST STE 4, LEWISTON, ID 83501-4455
(208) 743-2505
(208) 746-6395
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-3494
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5039532
—
WA
05
—
806332400
—
ID
Enumeration date
08/05/2006
Last updated
12/02/2010
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