Organization
KENT WAGNER JR DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD KENT WAGNER JR. DDS (DENTIST OWNER)
(702) 878-5599
Entity
Organization
Contact information
Practice address
2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
(702) 878-5599
(702) 878-0173
Mailing address
2045 VILLAGE CENTER CIRCLE, LAS VEGAS, NV 89134
(702) 878-5599
(702) 878-0173
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4799
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1779641
UNITED CONCORIDA PROVIDER
—
Enumeration date
08/04/2006
Last updated
08/22/2020
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