Individual
DR. CAROLYN BEAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
259 HYDRAULIC RIDGE RD, SUITE # 101, CHARLOTTESVILLE, VA 22901-8128
(434) 293-9300
Mailing address
3112 EARLYSVILLE RD, EARLYSVILLE, VA 22936-9563
(434) 963-7640
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401008312
VA
Other
Enumeration date
02/28/2006
Last updated
05/30/2011
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