Organization
DAVID A WAGNER DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID ALAN WAGNER D.D.S (OWNER/DENTIST)
(727) 797-5161
Entity
Organization
Contact information
Practice address
3023 EASTLAND BLVD, SUITE 112, CLEARWATER, FL 33761-4106
(727) 797-5161
(727) 797-5121
Mailing address
3023 EASTLAND BLVD, SUITE 112, CLEARWATER, FL 33761-4106
(727) 797-5161
(727) 797-5121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN13625
FL
332BC3200X
Customized Equipment (DME)
DN13625
FL
Other
Enumeration date
08/12/2016
Last updated
02/28/2017
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