Individual
DR. STEPHANIE NICOLE WAGONER KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
621 S PARK ST, MADISON, WI 53715-1827
(608) 251-3535
Mailing address
621 S PARK ST, MADISON, WI 53715-1827
(608) 251-3535
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6447-015
WI
Other
Enumeration date
08/26/2009
Last updated
08/26/2009
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