Individual
MICHAEL A WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
480 BROADWAY, PAWTUCKET, RI 02860
(401) 728-6654
(701) 728-5726
Mailing address
480 BROADWAY, PAWTUCKET, RI 02860
(401) 728-6654
(701) 728-5726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2342
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MW02273
—
RI
Enumeration date
06/17/2006
Last updated
07/08/2007
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