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Individual
DR. JOEL M WAGONER
Active
Individual
DR. JOEL M WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464231
ANTHEM BC
NC
01
—
535847
UCCI
NC
05
—
899015X
—
NC
01
—
9015X
BCBSNC
NC
Enumeration date
05/24/2005
Last updated
12/09/2010
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