Individual
DR. ELIZABETH ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
100 E LEHIGH AVE, PHILADELPHIA, PA 19125-1012
(215) 707-3613
Mailing address
1003 HANCOCK CT, DEPTFORD, NJ 08096-5122
(215) 837-3658
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS036569
PA
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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