Organization
WAGGONER PROFESSIONAL SERVICES PC
Active
Other names
Galaxy Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANTUNA (PRACTICE MANAGER)
(702) 254-4220
Entity
Organization
Contact information
Practice address
9575 W TROPICANA AVE STE 5, LAS VEGAS, NV 89147-8491
(702) 633-8331
Mailing address
9575 W TROPICANA AVE STE 5, LAS VEGAS, NV 89147-8491
(702) 633-8331
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
S6-17
—
Other
Enumeration date
07/27/2017
Last updated
07/21/2022
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