Organization
WAGNER, KUNTZ & GRABOUSKI
Active
Organization
WAGNER, KUNTZ & GRABOUSKI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WAGNER DDS (ORTHODONTIST)
(712) 258-0501
Entity
Organization
Contact information
Practice address
3021 HAMILTON BLVD, SIOUX CITY, IA 51104-2407
(712) 258-0501
(712) 258-1461
Mailing address
3021 HAMILTON BLVD, SIOUX CITY, IA 51104-2407
(712) 258-0501
(712) 258-1461
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6637
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025343600
—
NE
Enumeration date
08/15/2007
Last updated
08/15/2007
Update your record
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