Individual
ANDREW JOHNSTON WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
77 VILCOM CENTER DR, SUITE 110, CHAPEL HILL, NC 27514-1788
(919) 968-9697
(919) 942-3331
Mailing address
77 VILCOM CENTER DR, SUITE 110, CHAPEL HILL, NC 27514-1788
(919) 968-9697
(919) 942-3331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8321
NC
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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