Organization
THE FAMILY DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A. WAGNER DDS (PRESIDENT)
(401) 728-6654
Entity
Organization
Contact information
Practice address
480 BROADWAY, PAWTUCKET, RI 02860-1340
(401) 728-6654
(401) 728-5726
Mailing address
480 BROADWAY, PAWTUCKET, RI 02860-1340
(401) 728-6654
(401) 728-5726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2342
RI
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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