Individual
DR. NICHOLAS JOSEPH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889
Mailing address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011465A
IN
Other
Enumeration date
06/09/2010
Last updated
01/23/2020
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