NPI 1306231717

Nicholas J Wagner, DDS, LLC

Organisation Dentist Boonville, IN

Practice location

Address: 800 Office Park Dr, Boonville, IN 47601-8601
Phone: (812) 897-4889

Authorised official

Name: Nicholas J Wagner
Title: Dentist/Owner
Phone: (812) 897-4889

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 12011465A (IN)

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Registry record

NPI: 1306231717
Entity type: Organization
NPI issued: 2 Apr 2015
Record last updated: 2 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.