# MELINDA L. WAGNER DMD LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1891085569
- **Authorized official:** MELINDA L. WAGNER DMD (OWNER)
- **Authorized official phone:** (732) 747-2022

## Contact information

- **Practice address:** 191 BROAD ST., RED BANK, NJ 07701
- **Practice address phone:** (732) 747-2022
- **Practice address fax:** (732) 747-5524
- **Mailing address:** 191 BROAD ST., RED BANK, NJ 07701
- **Mailing address phone:** (732) 747-2022
- **Mailing address fax:** (732) 747-5524

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 14142 | NJ | Yes |

## Other

- **Enumeration date:** 04/14/2011
- **Last updated:** 04/14/2011