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NPI Code Detail

MEDICARE: WADE W. WAGNER, D.D.S., CHTD

MEDICARE: WADE W. WAGNER, D.D.S., CHTD
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
1122300000XDentist3199NV

General Provider Information

NPI Number : 1437279213
Entity Type Code : Organization
Provider Name (Legal Business Name) : WADE W. WAGNER, D.D.S., CHTD
Provider Business Mailing Address
First Line : 4618 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2956
Country : US
Telephone Number : 702-877-2222
Fax Number :
Provider Business Practice Location Address
First Line : 4618 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2956
Country : US
Telephone Number : 702-877-2222
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. WADE W. WAGNER SR.
Credential : D.D.S.
Telephone Number : 702-877-2222
Provider Enumeration Date : 03/29/2007
Last Update Date : 08/22/2020

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