Healthcare Provider Details

I. General information

NPI: 1821137399
Provider Name (Legal Business Name): CAMERON J WAGNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W SILVER SPRING DR #200
WHITEFISH BAY WI
53217
US

IV. Provider business mailing address

130 W SILVER SPRING DR #200
WHITEFISH BAY WI
53217
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-3870
  • Fax: 773-235-1249
Mailing address:
  • Phone: 414-939-3870
  • Fax: 773-235-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019027029
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: