Organization
WAGNER FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN M. WAGNER DDS (OWNER)
(812) 482-4347
Entity
Organization
Contact information
Practice address
4115 MANNHEIM RD, JASPER, IN 47546-2964
(812) 482-4347
Mailing address
PO BOX 712, JASPER, IN 47547-0712
(812) 482-4347
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12010568A
IN
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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