Individual
DR. RICHARD M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1925 SOUTH GREEN BAY RD, RACINE, WI 53406-4654
(262) 634-4646
(262) 634-4694
Mailing address
1925 SOUTH GREEN BAY RD, RACINE, WI 53406-4654
(262) 634-4646
(262) 634-4694
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3092
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33491300
—
WI
Enumeration date
04/19/2007
Last updated
07/08/2007
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