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Organization

NICHOLAS J WAGNER, DDS, LLC

Active
Other names
Warrick Park Dental
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NICHOLAS J WAGNER DDS (DENTIST/OWNER)
(812) 897-4889
Entity
Organization

Contact information

Practice address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889
Mailing address
800 OFFICE PARK DR, BOONVILLE, IN 47601-8601
(812) 897-4889

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011465A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1023338480
IN
05
1588740815
IN
Enumeration date
04/02/2015
Last updated
04/02/2015
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