Individual
DR. ERIC JOHN WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
112 2ND AVE NW, HAMPTON, IA 50441-1724
(641) 456-2625
(641) 456-2404
Mailing address
1643 HIGHWAY 65, HAMPTON, IA 50441-7444
(641) 456-5472
(641) 456-2404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
06932
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071928
—
IA
Enumeration date
03/31/2006
Last updated
07/08/2007
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