Individual
LISA ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1130 SANCTUARY PKWY, ALPHARETTA, GA 30009-4839
(770) 641-5168
Mailing address
425 PARIS DRIVE, LAWRENCEVILLE, GA 30043-6144
(770) 399-1582
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN010372
GA
Other
Enumeration date
11/15/2006
Last updated
09/20/2016
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