NPI 1083700231

Alexis Dawn Wagoner, DA

Practitioner Dental Assistant Longview, WA

Practice location

Address: 3902 Cottonwood St, Longview, WA 98632-4911
Phone: (360) 425-7753

Registered specialties

Dental Assistant Primary

Dental Providers Taxonomy 126800000X

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Registry record

NPI: 1083700231
Entity type: Individual
Sex (as registered): Female
NPI issued: 5 Oct 2006
Record last updated: 8 Jul 2007

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.