MEDICARE: DR. KURT ARTHUR WAGNER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	019021-094	IL

General Provider Information

NPI Number	:	1679644819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT ARTHUR WAGNER DDS

Provider Business Mailing Address
First Line	:	47 E CHICAGO AVE
Second Line	:	SUITE 344
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5325
Country	:	US
Telephone Number	:	630-778-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 E CHICAGO AVE
Second Line	:	SUITE 344
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5325
Country	:	US
Telephone Number	:	630-778-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/30/2020

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