Individual
DR. ROSS O. WAGSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 N SOUTH ST, WILMINGTON, OH 45177-1647
(937) 382-2041
Mailing address
150 N SOUTH ST, WILMINGTON, OH 45177-1647
(937) 382-2041
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-023499
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30-023499
DENTAL LICENSE
OH
Enumeration date
07/11/2011
Last updated
07/11/2011
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