# CARSON B. WAGSTAFF, DMD, PLC

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

## Provider details

- **NPI number:** 1932530151
- **Authorized official:** CARSON B WAGSTAFF DMD (OWNER)
- **Authorized official phone:** (801) 979-2035

## Contact information

- **Practice address:** 13435 N LON ADAMS RD, MARANA, AZ 85653
- **Practice address phone:** (801) 979-2035
- **Mailing address:** 13435 N LON ADAMS RD, MARANA, AZ 85653
- **Mailing address phone:** (801) 979-2035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/13/2013
- **Last updated:** 12/13/2013