Nicholas J Wagner, Dds, LLC

NPI #1306231717 in Boonville, Indiana

Provider Information

NPI Number: 1306231717
Entity Type: Organization
Organization Name: Nicholas J Wagner, Dds, LLC
Primary Specialty: Dentist
Enumeration Date: Apr 2, 2015
Last Updated: Apr 2, 2015

Practice Location

Address: 800 OFFICE PARK DR
City: Boonville
State: Indiana
ZIP Code: 47601-8601
Phone: (812) 897-4889

Authorized Official

Name: DR. NICHOLAS J WAGNER, DDS
Title: DENTIST/OWNER
Phone: (812) 897-4889

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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