Individual
DR. JIM A WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
2605 BROWNS LN, JONESBORO, AR 72401
(870) 972-5445
(870) 972-0852
Mailing address
2605 BROWNS LN, JONESBORO, AR 72401-7227
(870) 972-5445
(870) 972-0852
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2138
AR
Other
Enumeration date
08/25/2008
Last updated
08/25/2008
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