Organization
BAGLEY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANE LYNN WAGGONER (OFFICE MANAGER)
(218) 694-6571
Entity
Organization
Contact information
Practice address
13 MAIN AVE N, BAGLEY, MN 56621-0299
(218) 964-6571
(218) 694-6555
Mailing address
PO BOX 299, BAGLEY, MN 56621-0299
(218) 964-6571
(218) 694-6555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10792
MN
122300000X
Dentist
Primary
10965
MN
122300000X
Dentist
10967
MN
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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