Individual
DR. JOEL M WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
77 VILCOM CENTER DR, SUITE 110, CHAPEL HILL, NC 27514-1598
(919) 968-9697
(919) 942-3331
Mailing address
77 VILCOM CENTER DR, SUITE 110, CHAPEL HILL, NC 27514-1598
(919) 968-9697
(919) 942-3331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464231
ANTHEM BC
NC
01
—
535847
UCCI
NC
05
—
899015X
—
NC
01
—
9015X
BCBSNC
NC
Enumeration date
05/24/2005
Last updated
12/09/2010
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