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Organization
F JOHN WAGNER
Active
Organization
F JOHN WAGNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERIC JOHN WAGNER DDS (PRES)
(989) 544-2096
Entity
Organization
Contact information
Practice address
7791 MYSTIC LAKE DR, LAKE, MI 48632-9743
(989) 544-2096
Mailing address
7791 MYSTIC LAKE DR, LAKE, MI 48632-9743
(989) 544-2096
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10266
MI
Other
Enumeration date
12/08/2006
Last updated
08/22/2020
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