Individual
DR. JEFFREY PAUL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 256-2778
Mailing address
7527 JACOBO DR NE, ALBUQUERQUE, NM 87109-6425
(505) 821-4415
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1265
NM
Other
Enumeration date
04/26/2006
Last updated
07/08/2007
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