Individual
JON DAGLEY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD DDS
Contact information
Practice address
10000 COORS BYP NW, SUITE G-218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
Mailing address
10000 COORS BYP NW, SUITE G-218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
055441-1
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
28634
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DD3842
NM
208200000X
Plastic Surgery Physician
95-367
TX
Other
Enumeration date
08/02/2006
Last updated
04/04/2013
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