Individual
BOUAKEO WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
190 KINGWOOD AVE NW, SALEM, OR 97304-4030
(503) 315-0712
(503) 315-0721
Mailing address
14670 SE SALMON ST, PORTLAND, OR 97233-2568
(503) 949-4427
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H4345
OR
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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