Individual
MATTHEW ROBERT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2830 CURRY LN #1, GREEN BAY, WI 54311
(920) 432-7230
Mailing address
2830 CURRY LN #1, GREEN BAY, WI 54311
(920) 432-7230
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001719-15
WI
1223G0001X
General Practice Dentistry
22736
FL
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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