Organization
RUDOLPH M. WAGNER, DMD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDOLPH WAGNER DMD (ORTHODONTIST/ MANAGING MEMBER)
(727) 785-8847
Entity
Organization
Contact information
Practice address
2595 TAMPA RD STE I, PALM HARBOR, FL 34684-3131
(727) 785-8847
Mailing address
2595 TAMPA RD STE I, PALM HARBOR, FL 34684-3131
(727) 785-8847
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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