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Individual
TRAVIS WAYNE WAGNER
Active
Individual
TRAVIS WAYNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
17003
MD
1223G0001X
General Practice Dentistry
Primary
4340
WV
1223G0001X
General Practice Dentistry
DS042611
PA
Other
Enumeration date
06/01/2018
Last updated
08/19/2022
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