Organization
SPENCER B WAGNER DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER B WAGNER DMD (DENTIST)
(803) 632-3301
Entity
Organization
Contact information
Practice address
1987 ALLENDALE FAIRFAX HWY, FAIRFAX, SC 29827-9137
(803) 632-3301
(803) 632-1240
Mailing address
PO BOX 830, FAIRFAX, SC 29827-0830
(803) 632-3301
(803) 632-1240
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3192
SC
Other
Enumeration date
03/29/2006
Last updated
10/07/2008
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