Michael A Wagner, DDS

NPI #1639114622 in Pawtucket, Rhode Island

Provider Information

NPI Number: 1639114622
Entity Type: Individual
Name: Michael A Wagner, DDS
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Jun 17, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 480 BROADWAY
City: Pawtucket
State: Rhode Island
ZIP Code: 02860
Phone: (401) 728-6654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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