Individual
MELINDA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
191 BROAD ST, RED BANK, NJ 07701-2015
(732) 747-2022
(732) 747-5524
Mailing address
191 BROAD ST, RED BANK, NJ 07701-2015
(732) 747-2022
(732) 747-5524
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14142
NJ
Other
Enumeration date
04/08/2008
Last updated
04/08/2008
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