Individual
DR. WILLIAM WALTON WAGNILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10976 CEDAR LAKE RD, MINNETONKA, MN 55305-3366
(952) 544-2225
Mailing address
10976 CEDAR LAKE RD, MINNETONKA, MN 55305-3366
(952) 544-2225
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8960
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18477CE
BCBS FEDERAL PROVIDER ID
MN
01
—
309218600
MN PUBLIC HEALTH CARE ID
MN
Enumeration date
01/31/2007
Last updated
10/09/2012
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