Individual
DR. TARA MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4700 WHITE BEAR PARKWAY, WHITE BEAR LAKE, MN 55110-3336
(651) 762-7677
(651) 762-1861
Mailing address
1134 CREEKSIDE CIRCLE, STILLWATER, MN 55082
(651) 351-2987
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11791
MN
Other
Enumeration date
09/13/2006
Last updated
07/08/2007
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