Individual
DR. MICHAEL JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
13515 NE 175TH ST STE G, WOODINVILLE, WA 98072-8566
(425) 483-2600
(425) 483-4080
Mailing address
13515 NE 175TH ST STE G, WOODINVILLE, WA 98072-8566
(425) 483-2600
(425) 483-4080
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE00005880
WA
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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