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General NPI Number Information
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NPI Number | 1235386459
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Entity Type | Organization
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Legal Business Name | WAGNER & SCHUMAN DENTAL OFFICES
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 201 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1029
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Country | US
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Telephone | 505-266-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 201 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1029
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Country | US
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Telephone | 505-266-5881
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MAX WAGNER
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Credential | D.O.
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Telephone | 505-266-5881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DD788
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License Number State | NM
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