Individual
DR. PETER LOUIS WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1327 BISHOP RD, CHEHALIS, WA 98532-9263
(360) 748-6636
Mailing address
1327 BISHOP RD, CHEHALIS, WA 98532-9263
(360) 748-6636
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10580
OR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE60732747
WA
Other
Enumeration date
01/31/2017
Last updated
09/19/2024
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