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General NPI Number Information
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NPI Number | 1528182680
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Entity Type | Individual
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Provider Name | JOSHUA GRANT WAGNER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 7456 S SIMMS ST STE A-1
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City | LITTLETON
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State | CO
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Zip | 80127-3286
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Country | US
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Telephone | 720-981-5868
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Fax | 720-981-5809
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Provider Business Mailing Address
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Address Line | 7456 S SIMMS ST STE A-1
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City | LITTLETON
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State | CO
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Zip | 80127-3286
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Country | US
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Telephone | 720-981-5868
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Fax | 720-981-5809
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1093
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202788
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License Number State | CO
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