Organization
PETER C WAGNER DMD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER CARL WAGNER DMD (PRESIDENT)
(360) 748-6636
Entity
Organization
Contact information
Practice address
855 BROADWAY, LONGVIEW, WA 98632
(360) 425-2370
Mailing address
855 BROADWAY, LONGVIEW, WA 98632
(360) 425-2370
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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