Organization
ECCELLA SMILES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM SCOTT WAGNER DMD, PA (OWNER)
(904) 834-3737
Entity
Organization
Contact information
Practice address
1400 MARSH LANDING PKWY, SUITE 104, JACKSONVILLE BEACH, FL 32250-2493
(904) 834-3737
Mailing address
1400 MARSH LANDING PKWY, SUITE 104, JACKSONVILLE BEACH, FL 32250-2493
(904) 834-3737
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14961
FL
Other
Enumeration date
02/04/2015
Last updated
02/04/2015
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