Individual
EDWARD C WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2031 E HOSPITALTIY LN, STE 100, BOISE, ID 83716
(208) 333-9999
Mailing address
2031 E HOSPITALTIY LN, STE 100, BOISE, ID 83716
(208) 333-9999
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3528
ID
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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