Individual
DAVID ALAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
500 N LEROY ST, FENTON, MI 48430-2734
(810) 629-8272
(810) 629-3218
Mailing address
201S MICHIGAN AVE, BIG RAPIDS, MI 49307-1809
(231) 796-4747
(231) 796-5711
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
2901020879
MI
1223P0700X
Prosthodontics
DS038617
PA
Other
Enumeration date
02/11/2013
Last updated
07/14/2015
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