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NPI Code Detail

MEDICARE: LAUREN ELIZABETH WAGNER RDH, PHDHP

MEDICARE: LAUREN ELIZABETH WAGNER RDH, PHDHP
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
1124Q00000XDental Hygienist

General Provider Information

NPI Number : 1750026746
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN ELIZABETH WAGNER RDH, PHDHP
Provider Business Mailing Address
First Line : PO BOX 95
Second Line :
City : SUMMIT STATION
State : PA
Zip : 17979-0095
Country : US
Telephone Number : 570-640-1405
Fax Number :
Provider Business Practice Location Address
First Line : 1110 ROCKLAND ST
Second Line :
City : READING
State : PA
Zip : 19604-1501
Country : US
Telephone Number : 610-988-4838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2022
Last Update Date : 05/03/2022

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