Organization
ERIC J. WAGNER, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC WAGNER DDS (OWNER)
(641) 456-2625
Entity
Organization
Contact information
Practice address
112 2ND AVE NW, HAMPTON, IA 50441-1724
(641) 456-2625
(641) 456-2404
Mailing address
112 2ND AVE NW, HAMPTON, IA 50441-1724
(641) 456-2625
(641) 456-2404
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6932
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326009143
NPI, TYPE 1
IA
05
—
71928
—
IA
Enumeration date
05/19/2008
Last updated
05/19/2008
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