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General NPI Number Information
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NPI Number | 1811529522
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Entity Type | Organization
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Legal Business Name | WAGNER AUGUSTE DENTAL PLLC
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 206 HIGH ST STE D
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City | ELLSWORTH
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State | ME
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Zip | 04605-1741
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Country | US
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Telephone | 207-669-4826
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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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 | OWNER
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Name | ALAIN AUGUSTE
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Credential |
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Telephone | 207-669-4826
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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 |
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License Number State |
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