Individual
DR. STEPHEN A. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 ENCINO PL NE, SUITE A-3, ALBUQUERQUE, NM 87102-2612
(505) 232-3588
(505) 232-3593
Mailing address
801 ENCINO PL NE, SUITE A-3, ALBUQUERQUE, NM 87102-2612
(505) 232-3588
(505) 232-3593
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
1150
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82743
—
NM
Enumeration date
08/17/2005
Last updated
04/30/2014
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