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Organization
YEN WAGNER DDS LLC
Active
Organization
YEN WAGNER DDS LLC
Active
Other names
Brighter Image Dental
Organization subpart
No
Provider details
NPI number
Authorized official
YEN WAGNER DDS (OWNER)
(317) 925-5811
Entity
Organization
Contact information
Practice address
3965 N MERIDIAN ST APT 1C, INDIANAPOLIS, IN 46208-4035
(317) 925-5811
Mailing address
3965 N MERIDIAN ST APT 1C, INDIANAPOLIS, IN 46208-4035
(317) 925-5811
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12010286A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200919550
—
IN
Enumeration date
01/12/2010
Last updated
01/12/2010
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