Organization
WILL WAGNER D.M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILL WAGNER D.M.D. (MEMBER)
(205) 349-9092
Entity
Organization
Contact information
Practice address
1663 MCFARLAND BLVD N, SUITE G-5, TUSCALOOSA, AL 35406-2250
(205) 349-9092
Mailing address
620 HARTFORD DR, TUSCALOOSA, AL 35406-1799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5177
AL
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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