Individual
CAMERON J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2632 W DIVISION ST, CHICAGO, IL 60622-2850
(773) 235-0980
(773) 235-1249
Mailing address
2632 W DIVISION ST, CHICAGO, IL 60622-2850
(773) 235-0980
(773) 235-1249
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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