Organization
MICHAEL J. WAGNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN WAGNER DMD, PS (OWNER/ ORTHODONTIST)
(425) 483-2600
Entity
Organization
Contact information
Practice address
13515 NE 175TH ST, SUITE G, WOODINVILLE, WA 98072-8566
(425) 483-2600
(425) 483-0840
Mailing address
13515 NE 175TH ST, SUITE G, WOODINVILLE, WA 98072-8566
(425) 483-2600
(425) 483-0840
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
602680925
WA
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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