Custom Dental Care, P.c.

NPI #1932452893 in Quincy, Illinois

Provider Information

NPI Number: 1932452893
Entity Type: Organization
Organization Name: Custom Dental Care, P.c.
Primary Specialty: Dentist
Enumeration Date: Oct 17, 2012
Last Updated: Oct 17, 2012

Practice Location

Address: 3740 E LAKE CTR STE B
City: Quincy
State: Illinois
ZIP Code: 62305-5805
Phone: (217) 214-4545

Authorized Official

Name: DR. DENNIS RYAN WAGNER, D.M.D.
Title: OWNER/PRESIDENT
Phone: (217) 430-1429

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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