Organization
RIVERTON SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA G WAGNER D.D.S (DENTIST)
(307) 856-3463
Entity
Organization
Contact information
Practice address
1224 EAST JACKSON AVE, RIVERTON, WY 82501-3841
(307) 856-3463
(307) 856-9910
Mailing address
1224 E JACKSON AVE, RIVERTON, WY 82501-3841
(307) 856-3463
(307) 856-9910
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1093
WY
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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