Individual
SCOTT WILLIAM WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9035 EAST 62ND STREET SOUTH, TULSA, OK 74133
(918) 622-3915
(918) 662-3922
Mailing address
9035 E 62ND ST SO, TULSA, OK 74133
(918) 622-3915
(918) 994-6870
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5335
OK
Other
Enumeration date
09/06/2006
Last updated
06/05/2014
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