Organization
DRS. WAGONER & WAGONER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON D. WAGONER DDS, MAGD (PRESIDENT)
(574) 967-4434
Entity
Organization
Contact information
Practice address
17 S DIVISION ST, FLORA, IN 46929-1335
(574) 967-4434
(574) 967-4426
Mailing address
17 S DIVISION ST, FLORA, IN 46929-1335
(574) 967-4434
(574) 967-4426
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007394
IN
1223G0001X
General Practice Dentistry
12009376
IN
Other
Enumeration date
05/22/2007
Last updated
08/22/2020
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