Individual
SUSAN ELAINE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8849 SHELBY ST, A-2, INDIANAPOLIS, IN 46227-7508
(317) 881-4000
(317) 888-1762
Mailing address
8849 SHELBY ST, A-2, INDIANAPOLIS, IN 46227-7508
(317) 881-4000
(317) 888-1762
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008739
IN
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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