Individual
CHARLES ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2860 VALENCIA DR, IDAHO FALLS, ID 83404-7597
(855) 433-6825
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(503) 952-2125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2971138
ID
1223G0001X
General Practice Dentistry
D7442
OR
Other
Enumeration date
12/29/2006
Last updated
07/29/2026
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