Individual
HANNAH MICHELE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5629 VINE ST STE C9, PHILADELPHIA, PA 19139
(215) 383-1376
Mailing address
1420 LOCUST ST APT 14Q, PHILADELPHIA, PA 19102-4203
(215) 630-0229
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS045529
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2024
Last updated
03/02/2026
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