Individual
JENNAH CASTLEMAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
104 FORBES ST STE 204, ANNAPOLIS, MD 21401-1598
(410) 295-1000
Mailing address
8143 RIDGELY LOOP, SEVERN, MD 21144-2835
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
33499
TX
1223P0300X
Periodontics
Primary
18973
MD
1223P0300X
Periodontics
33499
TX
Other
Enumeration date
09/13/2017
Last updated
01/20/2026
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