Organization
WAGNER FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT FREDERICK WAGNER D.M.D. (OWNER/PRESIDENT)
(503) 239-5115
Entity
Organization
Contact information
Practice address
2803 NE EVERETT ST, PORTLAND, OR 97232-3246
(503) 239-5115
(503) 231-6480
Mailing address
2803 NE EVERETT ST, PORTLAND, OR 97232-3246
(503) 239-5115
(503) 231-6480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7549
OR
Other
Enumeration date
04/11/2011
Last updated
06/08/2011
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