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General NPI Number Information
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NPI Number | 1235257221
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Entity Type | Individual
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Provider Name | CHADWIN J WAGENER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 340 SE DELAWARE AVE
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City | ANKENY
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State | IA
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Zip | 50021-9346
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Country | US
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Telephone | 515-964-5482
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Fax | 515-964-1956
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Provider Business Mailing Address
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Address Line | 833 SE LAURIE LN
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City | ANKENY
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State | IA
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Zip | 50021-3667
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Country | US
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Telephone | 515-964-5482
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Fax | 515-964-1956
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7472
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License Number State | IA
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