Individual
MR. DANIEL JAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1303 DR MARTIN L KING JR AVE, MOBILE, AL 36603-5341
(251) 432-4112
(251) 964-4012
Mailing address
PO BOX 2048, MOBILE, AL 36652-2048
(251) 432-4117
(251) 964-4012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
LNO3646
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6314000180
—
AL
Enumeration date
06/29/2006
Last updated
07/08/2007
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