Healthcare Provider Details

I. General information

NPI: 1558337584
Provider Name (Legal Business Name): WILLIAM F. WAGGONER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 W SAHARA AVE STE 110
LAS VEGAS NV
89117-5894
US

IV. Provider business mailing address

8981 W SAHARA AVE STE 110
LAS VEGAS NV
89117-5894
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-4220
  • Fax:
Mailing address:
  • Phone: 702-254-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS617
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: