Individual
MR. DENNIS RYAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
407 SOUTH 48TH ST, QUINCY, IL 62305
(217) 228-9467
(217) 228-0131
Mailing address
912 COUNTRY CLUB HEIGHTS, APT 103, QUINCY, IL 62301
(217) 221-8534
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
07/11/2007
Last updated
07/11/2007
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