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General NPI Number Information
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NPI Number | 1750026746
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH WAGNER RDH, PHDHP
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Gender | Female
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 1110 ROCKLAND ST
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City | READING
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State | PA
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Zip | 19604-1501
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Country | US
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Telephone | 610-988-4838
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | SUMMIT STATION
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State | PA
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Zip | 17979-0095
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Country | US
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Telephone | 570-640-1405
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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