Individual
DR. CHAD LOWELL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
301 FISHER ST, BILOXI, MS 39534-2508
(651) 600-7104
Mailing address
301 FISHER ST, BILOXI, MS 39534-2508
(651) 600-7104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
111707
MS
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
11918999-2903
UT
Other
Enumeration date
12/07/2020
Last updated
10/08/2025
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