Individual
MRS. ELIZABETH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
103 E. FOUNTAIN ST., DODGEVILLE, WI 53533-1749
(608) 935-5550
(608) 935-5168
Mailing address
2901 W. BELTLINE HWY., STE. 120, MADISON, WI 53713-4226
(608) 443-5500
(608) 441-1981
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
11805
GA
1223G0001X
General Practice Dentistry
Primary
4920-15
WI
Other
Enumeration date
10/31/2006
Last updated
04/13/2012
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