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General NPI Number Information
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NPI Number | 1245759976
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Entity Type | Individual
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Provider Name | JENNAH CASTLEMAN WAGNER DMD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 104 FORBES ST STE 204
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1598
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Country | US
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Telephone | 410-295-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 8143 RIDGELY LOOP
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City | SEVERN
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State | MD
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Zip | 21144-2835
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Country | US
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Telephone |
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 33499
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License Number State | TX
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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 | 18973
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33499
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License Number State | TX
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