# WAGONER FAMILY DENTISTRY, PC

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

## Provider details

- **NPI number:** 1821276817
- **Authorized official:** MICHAEL K CRAIG D.D.S. (OWNER)
- **Authorized official phone:** (918) 485-2200

## Contact information

- **Practice address:** 900 E CHEROKEE ST, WAGONER, OK 74467-4718
- **Practice address phone:** (918) 485-2200
- **Practice address fax:** (918) 485-8877
- **Mailing address:** 900 E CHEROKEE ST, WAGONER, OK 74467-4718
- **Mailing address phone:** (918) 485-2200
- **Mailing address fax:** (918) 485-8877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5069 | OK | Yes |

## Other

- **Enumeration date:** 02/01/2008
- **Last updated:** 02/01/2008