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Organization
KENT WAGNER JR DDS PC
Active
Organization
KENT WAGNER JR DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD KENT WAGNER JR. DDS (DENTIST OWNER)
(702) 878-5599
Entity
Organization
Contact information
Practice address
2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
(702) 878-5599
(702) 878-0173
Mailing address
2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
(702) 878-5599
(702) 878-0173
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4799
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1779641
UNITED CONCORIDA PROVIDER
—
Enumeration date
08/04/2006
Last updated
08/22/2020
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