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General NPI Number Information
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NPI Number | 1174664460
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Entity Type | Organization
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Legal Business Name | LEHMAN WAGGENER PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 80 DOCTORS PARK DRIVE
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-1836
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Fax | 707-542-0617
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Provider Business Mailing Address
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Address Line | 80 DOCTORS PARK DRIVE
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-1836
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Fax | 707-542-0617
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELLY JOHANNA WAGGENER
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Credential | DMD
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Telephone | 707-538-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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