Healthcare Provider Details

I. General information

NPI: 1134475320
Provider Name (Legal Business Name): ERIC THOMAS WAGAR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16653 108TH AVE SE
RENTON WA
98055-5108
US

IV. Provider business mailing address

16653 108TH AVE SE
RENTON WA
98055-5108
US

V. Phone/Fax

Practice location:
  • Phone: 425-226-1244
  • Fax:
Mailing address:
  • Phone: 425-226-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60284727
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: