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NPI Code Detail

MEDICARE: DR. WILLIAM COLE WAGGENER IV DDS

MEDICARE: DR. WILLIAM COLE WAGGENER IV DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN23307FL

General Provider Information

NPI Number : 1184114241
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM COLE WAGGENER IV DDS
Provider Business Mailing Address
First Line : 115 PARNELL ST
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-4715
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 PARNELL ST
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32953-4715
Country : US
Telephone Number : 321-452-8190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2018
Last Update Date : 05/15/2018

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Directions to “ DR. WILLIAM COLE WAGGENER IV DDS” Practice Location

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