Individual
DR. ELYSE ANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
93 UNION ST STE 402, NEWTON CENTRE, MA 02459-2241
(179) 650-0606
Mailing address
93 UNION ST STE 402, NEWTON CENTRE, MA 02459-2241
(617) 965-0060
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
DN1858351
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2018
Last updated
05/07/2021
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