Individual
KENNETH WAGSCHAL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11818 ROCKAWAY BLVD, JAMAICA, NY 11420-2420
(718) 843-5231
(718) 843-1022
Mailing address
1770 E 21ST ST, BROOKLYN, NY 11229-1515
(718) 710-2247
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
035430
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00535084
—
NY
Enumeration date
12/27/2005
Last updated
07/08/2007
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