| NPI | 1902896772 |
|---|---|
| Other Name | DR JEREMY WIGGINS |
| Entity Type | Organization |
| Authorized Contact | LAURIE LESTER Office Manager 208-743-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3494) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2010-12-02 |