Organization
PETER C. WAGNER, D.M.D., P.S.
Active
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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