Individual
DR. SPENCER B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
2520 N UNIVERSITY AVE, SUITE 101, PROVO, UT 84604-3804
(801) 426-6255
(801) 224-2966
Mailing address
2520 N UNIVERSITY AVE, SUITE 101, PROVO, UT 84604-3804
(801) 426-6255
(801) 224-2966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3192
SC
122300000X
Dentist
6026130
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z31920
—
NC
Enumeration date
02/25/2008
Last updated
01/04/2013
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