Individual
DR. ROBERT GENE WAGONER II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
801 N. ELM STREET, HENDERSON, KY 42420-2705
(270) 212-0330
(270) 212-0332
Mailing address
801 N. ELM STREET, HENDERSON, KY 42420-2705
(270) 212-0330
(270) 212-0332
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7298
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
7298
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000299338
ANTHEM BLUE CROSS BLUE SH
KY
05
—
60002003
—
KY
05
—
64063514
—
KY
Enumeration date
11/02/2006
Last updated
09/04/2012
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