Individual
DR. STEPHANIE ANN WAGNER KETHCART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
(602) 812-4326
(602) 883-7252
Mailing address
1277 E MISSOURI AVE STE 102, PHOENIX, AZ 85014-2916
(602) 615-8516
(602) 883-7252
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6695
AZ
Other
Enumeration date
07/06/2006
Last updated
08/10/2019
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