Cosmetic and Family Dentistry of Marietta

Primary specialty

DentistTaxonomy code 122300000X

License

DN012485 Issued in GA

Legal business name

COSMETIC AND FAMILY DENTISTRY OF MARIETTA

Practice address

1611 Sands PL SE Ste 100
Marietta, GA 30067-8704

Phone

(770) 226-0008

Fax

(770) 226-0700

NPI assigned

Aug 18, 2008

Last updated

Aug 18, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

COSMETIC AND FAMILY DENTISTRY OF MARIETTAAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Morris Wiggins Jr., DDSNPI 1780805135

Title

Dr./Dentist

Phone

(770) 226-0008

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Cosmetic and Family Dentistry of Roswell Other name

Part of

Cosmetic and Family Dentistry of Marietta

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth Morris Wiggins Jr., D.D.S.

  • Dentist
  • Marietta, GA
  • NPI 1780805135
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1023264322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7718",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300651718",
            "telephone_number": "770-226-0008",
            "fax_number": "770-226-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 SANDS PL SE STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678704",
            "telephone_number": "770-226-0008",
            "fax_number": "770-226-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC AND FAMILY DENTISTRY OF MARIETTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COSMETIC AND FAMILY DENTISTRY OF MARIETTA",
        "enumeration_date": "2008-08-18",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MORRIS",
        "authorized_official_title_or_position": "DR./DENTIST",
        "authorized_official_telephone_number": "770-226-0008",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012484",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829858019A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829858019B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cosmetic and Family Dentistry of Roswell",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Donald Ray Cornutt Jr., MD
• Judy T Cornwell, NP-C
• Kelli Cortes, LCSW
• Tracey Cos, RDN, LD
• Julie Claire Cosgrove, CPNP
• Barbara Cossman, CPNP
• Amanda Costa Sakraida, M.ED., SLP
• Fernanda Costa, ACNPC-AG
• Lauren Costley
• Alexis Costlow, PT, DPT

• Dentist in Marietta, GA
• Providers in Marietta, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.