Organization
YEN WAGNER DDS LLC
Active
Other names
Brighter Image Dental
Organization subpart
No
Provider details
NPI number
Authorized official
YEN WAGNER DDS (OWNER)
(317) 925-5811
Entity
Organization
Contact information
Practice address
3965 N MERIDIAN ST APT 1C, INDIANAPOLIS, IN 46208-4035
(317) 925-5811
Mailing address
3965 N MERIDIAN ST APT 1C, INDIANAPOLIS, IN 46208-4035
(317) 925-5811
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12010286A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200919550
—
IN
Enumeration date
01/12/2010
Last updated
01/12/2010
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