Individual
DR. BRIAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 S DIVISION ST, FLORA, IN 46929-1335
(574) 967-4434
Mailing address
17 S DIVISION ST, FLORA, IN 46929-1335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009376
IN
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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