Individual
DR. BRANDON MARK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
403 S 11TH ST STE 200, BOISE, ID 83702-6968
(208) 342-3440
Mailing address
403 S 11TH ST STE 200, BOISE, ID 83702-6968
(208) 342-3440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5306
ID
Other
Enumeration date
06/25/2021
Last updated
09/08/2025
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