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Organization
STEPHEN A. WAGNER DDS,PC
Active
Organization
STEPHEN A. WAGNER DDS,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN A WAGNER DDS,PC (MAXILLOFACIAL PROSTHODONTIST)
(505) 232-3588
Entity
Organization
Contact information
Practice address
801 ENCINO PL NE STE A3, ALBUQUERQUE, NM 87102-2639
(505) 232-3588
(505) 232-3593
Mailing address
801 ENCINO PL NE STE A3, ALBUQUERQUE, NM 87102-2639
(505) 232-3588
(505) 232-3593
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD1150
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82743
—
NM
Enumeration date
09/02/2009
Last updated
09/02/2009
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