MEDICARE: WILLIAM F. WAGGONER, DDS, MS, CHRTED

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1568691491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM F. WAGGONER, DDS, MS, CHRTED

Provider Business Mailing Address
First Line	:	8981 W SAHARA AVE
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5897
Country	:	US
Telephone Number	:	702-254-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	8981 W SAHARA AVE
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5897
Country	:	US
Telephone Number	:	702-254-4220
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. WILLIAM FRANKLIN WAGGONER
Credential	:	DDS
Telephone Number	:	702-254-4220

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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