# DR. CHADWIN J WAGENER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1235257221
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7472 | IA | Yes |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01396 | BLUE DENTAL PROV ID | IA |
| 01 | — | 769242 | UNITED CONCORDIA PROV ID | IA |