Individual
DR. CHADWIN J WAGENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
340 SE DELAWARE AVE, ANKENY, IA 50021-9346
(515) 964-5482
(515) 964-1956
Mailing address
833 SE LAURIE LN, ANKENY, IA 50021-3667
(515) 964-5482
(515) 964-1956
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7472
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01396
BLUE DENTAL PROV ID
IA
01
—
769242
UNITED CONCORDIA PROV ID
IA
Enumeration date
03/27/2007
Last updated
07/08/2007
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