Individual
DR. ERIC JAMES WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
835 WAKE FOREST BUSINESS PARK STE E, WAKE FOREST, NC 27587-7324
(919) 570-7930
Mailing address
835 WAKE FOREST BUSINESS PARK STE E, WAKE FOREST, NC 27587-7324
(919) 570-7930
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9367
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5921749
—
NC
Enumeration date
10/04/2012
Last updated
07/21/2022
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