Organization
PETER C. WAGNER, D.M.D., P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER C. WAGNER D.M.D., P.S. (PRESIDENT)
(360) 748-6636
Entity
Organization
Contact information
Practice address
1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
(360) 748-6636
(360) 748-3176
Mailing address
1292 S MARKET BLVD, CHEHALIS, WA 98532-3645
(360) 748-6636
(360) 748-3176
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6937
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5028469
—
WA
Enumeration date
03/21/2007
Last updated
08/22/2020
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