# KENT WAGNER JR DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336157270
- **Authorized official:** RONALD KENT WAGNER JR. DDS (DENTIST OWNER)
- **Authorized official phone:** (702) 878-5599

## Contact information

- **Practice address:** 2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
- **Practice address phone:** (702) 878-5599
- **Practice address fax:** (702) 878-0173
- **Mailing address:** 2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
- **Mailing address phone:** (702) 878-5599
- **Mailing address fax:** (702) 878-0173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4799 | NV | Yes |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1779641 | UNITED CONCORIDA PROVIDER | — |